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May affect the way payment is made by 3rd party payers


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

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


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.


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?


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?


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?


What is the term that describes the services provided to a patient by the physician before surgery


What is another term for the time after the surgery that the physician provides services to the patient?


Do all third party payers recognize all modifiers as listed in the CPT manual?


What is the term that decribes two physicians working together in the completion of a procedure when each has the same level of responsibility


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