21 terms

Procedural Coding

Code Modifiers Anesthesia/Physical Modifiers Append. A Modifiers
A normal Health person
A patient with mild systemic disease
A patient with severs systemic disease
A patient with severe systemic disease that is a constant threat to life
A moribund patient who is not expected to survive without the operation
A declared brain-dead patient whose organ are being removed for donor purposes
Increased Procedural Services(this modifier should not be appended to E/M services).
Unusual Anestheia-a procedure which usually requires either no anestheia or local anestheia, because of unusual circumstances must be done under general anestheia . This circumstance may be reported by using this modifier to the procedure code of the basic service.
Unrelated Evaluation & Management Service by the Same Physician during a postoperative period.The physician may need to indicate that a evaluation & management service was preformed during a postoperative period for reason(s) unrelated to the original procedure.
Significant, Separately Identifiable Evaluation & management Service by the Same Physician on the Same Day of the Procedure or Other Service. It may be necessary to indicate that on the day of a procedure or service identified by CPT code was preformed, the patient's condition required a significant,separately identifiable E/M service above & beyond the other service provided or beyond the usual preoperative & postoperative care associatedwith the procedure that was preformed.
Professional Component:Certain procedure are a combination of a physical component & a technical component. When the physician component is reported separately, theservice may be identifiable by this modifier.
Mandated Service:Services related to mandated consultation &/or related services(eg, third party payer, govermental, legislative, or regulatory requirements) may be identified with this modifier.
Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are preformed at the same operative session, should be identified by adding this modifier to the appropiate 5 digit code.
Multiply Procedures:When multiple procedures, other than E/M Services, Physical Medicine & Rehabilitation services or provision of supplies(vaccines), are preformed at the same session by the same provider, the primary procedure(s) or service(s) my be identified by this modifier to the additional procedure or service code.
Reduced Services: Under certain circumstancesa service or procedure is partially reduced or eliminated at the physician's discretion. Under thses circumstances the service provided can be identified by it usual procedure code & the addition of the modifier, signifying that the service has been reduced. For hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after the administration of anestheia, see medifier 73 & 74
Discontinued Procedure: Under certain circumstances the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance my be reported by adding this modifier to the code reported by the physician for the discontinued procedure
Surgical Care Only: When one physician preforms a surgical procedure & another provides preoperative &/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code.
Postoperative Management Only: When one physician preforms the postoperative management & another preformed the surgical procedure, the postoperative component may be identified by adding this modifier to the usual procedure code.
Preoperative Management Only:When one physician performed the preoperative care & evaluation & another physician preformed the surgicial procedure, the preoperative component may be identified by adding this modifier to the usual procedure code.
Decision for Surgery: An Evaluation & Management service that resulted in the initial decision to perform surgery may be identified by adding this modifier to the appropriate level of E&M service.
Staged or Related Procedure or Service by the Same Physician During Postoperative Period:It may be necessary to indicate that the performance of a procedure or serviceduring the postoperative period was: a) planned or anticipated(staged); b) more extensive than the original procedure; or c) for therapy following a surgical procedure.