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34 terms

Modifiers Chapter 14 Test

STUDY
PLAY
May affect the way payment is made by 3rd party payers
Modifiers
Modifiers are used to indicate
Bilateral procedure, Multiple Procedures, Service greater than required
Modifier -57
Decision for surgery can be used with an E/M code
Modifier -79
Unrelated procedure or service by the same physician during the past.
Op period
Can only be used with a surgery code
Modifier -51
Multiple procedure, can only be used with a surgery code
Modifier -80
Assistant Surgeon, is used when a 2nd surgeon provides assistance to primary surgeon
Modifier -32
Indicates a service is mandated. Ex- an insurance company requires a 2nd opinion prior to surgery
Modifier -59
Distinct procedure service indicates services that are usually bundled into one payment were provided as separate
services
Modifier -25
Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service is used to report an E/M service provided on the same day as a minor procedure performed by the same physician
Modifier -58
Staged or related procedure or service by the same physician during the post op period indicates a subsequent surgery was planned at the time of the 1st surgery
Modifier -52
Reduced services- a service was reduced without changing the definition of the code
Modifier -AA
Is a HCPCS modifier- is used to report anesthesia services performed personally by anesthesiologist or when an anesthetist assists a physician ...
Modifier- 99
Multiple Modifiers
Modifier- 26
Professional component
Modifier- 51
Indicates multiple procedures
Apendix A
Lists some HCPCS modifiers
TC
Tecchnical component of a diagnostic procedure
Modifier- 90
Used to indicate services of an outside laboratory
When two or more physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion to complete.
Surgical Team
This modifier indicates an increased service and is overused and results in an increase in payment of 20%-30%. As such, assignment of this modifier comes under scrutiny by 3rd party payers.
Modifier -22
When modifier -54 is assigned payment for the ___________ portion of the surgical procedure is being requested.
Inoperative
Joan assigned modifier -32 to an E/M consultation code 99244. Medical records shows request was made by patient's spouse. Is Joan correct?
No, this modifier is NOT to be used to report 2nd opinion requested by a patient, spouse or another physician
It is only appended to other than E/M codes
Modifier -59
What is the weight in pounds of a 4-kilogram infant?
8.8
Which two statements are not true about modifier -53?
Describes circumstances based on the patients preoperative condition
describes circumstances in which the patient cancelled the procedure
Modifier -57 can be added to Surgery section codes?
False
When adding multiple CPT modifiers to a code, you would list the modifiers from
Highest to lowest
What appendix in the CPT manual contains a complete list of all modifiers?
Appendix A
What is the word that means assigning multiple codes when one code would do?
Unbundling
What is the term that describes the services provided to a patient by the physician before surgery
Pre-operative
What is another term for the time after the surgery that the physician provides services to the patient?
Post-operative
Do all third party payers recognize all modifiers as listed in the CPT manual?
No
What is the term that decribes two physicians working together in the completion of a procedure when each has the same level of responsibility
Co-surgeons