Unrelated E/M Services by the Same Physician During a Postoperative Period
Significant Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service
Anesthesia by Surgeon
Surgical Care Only
Postoperative Management Only
Preoperative Management Only
Decision for Surgery
Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Distinct Procedural Service
Procedure Performed on Infants Less than 4 kg
Repeat Procedure or Service by Same Physician
Repeat Procedure by Another Physician
Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the postoperative Period
Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Minimum Assistant Surgeon
Assistant Surgeon (When Qualified Resident Surgeon Not Available)
Reference (Outside) Laboratory
Repeat Clinical Diagnostic Laboratory Test
Alternative Laboratory Platform Testing
When more than two physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion of the surgery to complete, they are term what?
This modifier indicates an increased service and is overused and results in an increase in payment of 20% to 30%. As such, the assignment of this modifier comes under particularly close scrutiny by third-party payers. What is this modifier?
Payment for the intraoperative or surgery portion of the surgical procedure is being requested.
Only to other than E/M codes
What is the weight in pounds of a 4-kilogram infant?
(Postoperative Management Only) should be assigned when a provider other than the surgeon is responsible for postoperative management.
National Correct Coding Initiative
National Correct Coding Initiative (NCCI)
Implemented by the American Medical Association
A service that has been partially reduced at the physician's discretion is reflected by the modifier
Modifiers -23, -52, and -73
When the provider performs a procedure or service for which there is no CPT code, the coder should assign
National Correct Coding Initiative (NCCI)
Automated edits that identify pairs of services that normally should not be billed by the same physician for the same patient on the same day are part of the
What is a functional modifier
It is a pricing modifier, which means that the third-party payer considers it when determining reimbursement
When two primary surgeons are required during an operative, each performing distinct parts of a reportable procedure, modifier ___________ should be assigned.
When a procedure was repeated because of special circumstances involving the original service and the same physician performed the repeat procedure, modifier ____ should be recorded.
Workers' Compensation referred a patient to a physician for a mandatory examination to determine the legitimacy of a claim (insurance certification). What modifier would be added to the code for the examination service?
Dr. Ramus administers regional anesthesia by intravenous injection (also known as Bier's local anesthesia) for a surgical procedure on the patient's lower arm. Dr. Ramus then performs the surgical procedure. What modifier would be added to the surgical code.
A patient came to the office twice in one day to see the same physician for unrelated problems. What modifier would be added to the code for the second office visit?
Modifier -51 - There are three significant times when multiple procedures are reported:
1. Same Operation, Different Site 2. Multiple Operation(s), same Operative Session 3. Procedure Performed Multiple Times
Modifier -54, -55, and -56
When reporting his or her own individual services, each physician would use the same procedure code for the surgery, letting the modifier indicate to the third-party payer the part of the surgical package that each personally performed.
What appendix in the CPT manual contains a complete list of all modifiers?
What is the term that describes the services provided to a patient by the physician before surgery?
When listing multiple CPT modifiers, you would list them from:
Highest to lowest
Which of the following statements is true about modifier?
may be used to describe those times when the physician elects to terminate a procedure due to the well-being of the patient
Dr. Wells began surgery on an 86-year-old female with severe hypertension. The patient was satisfactorily anesthetized and the site opened to view. Shortly thereafter, the patient's blood pressure dropped significantly, and the physician was unable to stabilize the patient. The procedure was discontinued.
The patient is a 10-month-old boy who fell while trying to walk. He cut the bottom of his lip open. Sutures are necessary, but due to the patient's age and excessive movement, general anesthesia is needed.
A patient has a hernia repair and 2 days later must be returned to the operating room for a dehiscence of the incision. When coding the secondary hernia repair, which modifier would you add onto the surgical codes?
A surgeon performed a repair of an enterocele using an abdominal approach and reported the service with 57270. Then patient was morbidly obese with a BMI of 42, and due to this circumstance, the procedure took a significant amount of additional time to perform.
During a radical right descended orchiectomy for an extensive malignant tumor (54435), the patient began to hemorrhage. After considerable time and effort, the hemorrhage was controlled.
The modifier -RT and LT are:
Right and Left, Never used with Modifier -50, and HCPCS modifiers
Which group of modifier, are most likely NOT to be recognized by insurance carriers?
Modifier -22; May still not be compensated at a higher rate, even with a report, if the carrier doesn't agree.
The modifier -23, ____________ would not be appropriate for the use of a accupuncture
Modifier -24 should always be used with:
Evaluation and Management codes.
Used for the initial evaluation of a problem for which a procedure is performed.
If general anesthesia is applied, modifier -23 should be used when your CPT manual notes under the CPT code:
Procedure "usually performed without anesthesia or under local anesthesia."
Some CPT codes are "Technical Service only". This means:
Only the "facility", most often a hospital, would bill for services (use of the equipment.)
The use of a magnifying surgical loupe qualifies the use of modifier -20, microsurgery:
Modifier -20 has been deleted from CPT and can no longer be used.
Which of the following modifiers are considered informational only (will not impact reimbursement)?
Modifiers -24, -32, and -57
What the percentage amounts allocated for Modifier -54, -55, and -56, respectively?
70%, 20%, 10%
What the percentage amounts for modifier -54?
What the percentage amounts for modifier -55?
What the percentage amounts for modifier -56?
What is the word that means assigning multiple codes when one code would do?
What is another term for the time after the surgery that the physician provides services to the patient?
A patient is admitted and has bilateral arthroscopy of the knees due to Baker's cysts.
A radiological examination of the gastrointestinal tract was ordered by a third-party payer for a confirmation of Crohn's disease (regional enteritis) of the large bowel.
Anesthesia provided by the ENT physician during a tympanoplasty for repair of a tympanic membrane perforation.
A patient is seen at the direction of Workers' Compensation for a complete physical examination for insurance certification.
The patient returns to the operating room for removal of deep pins during the postoperative period, due to complication (dislodged) after an open repair of a humerus fracture.
A patient has a surgical procedure on Turesday, and later that day the physician must take the patient back to the operating room to repeat (redo) a coronary bypass, due to complications of initial procedure.
The patient underwent a bilateral tympanoplasty.
If you must use two or more modifiers to describe a service, you would use which modifier to indicate this circumstance?
A surgeon performs a procedure on a neonate weighing 9kg; the procedure was extremely complicated. What modifier would you use to indicate this service, which has an increased level of complexity?
Dr. Storely performed cataract surgery on 10/31/2008 and Dr. Jones provided postoperative care following discharge. What modifier would you use to indicate the postoperative care following discharge?
Dr. Merideth serves as an assistant surgeon to Dr. Taylor. What modifiers; would you add to the procedure code to indicate Dr. Merideth's status during the procedure?
The third-party payer requires the use of HCPCS/National modifiers; the surgeon performed a surgical procedure on the patient's left thumb. What Level II modifier would indicate the left thumb?
What Level II modifier indicates the upper left eyelid?
Which modifier is requests payment for the full fee of the subsequent service because it was unassociated with the first procedure. A new global period should start when modifier _____ is submitted