Coding ahead: LIST OF MODIFIERS

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"CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association."

Home based Medical Coding Jobs

LIST OF MODIFIERS

ICD - 9 to ICD - 10 Online Code Conversion Tool

LABELS

CPT updates (79)

Medicare Reimbursement Guidelines (42) Medicare Learning Network (MLN) updates (38) Modifier updates (38) FAQs (36) 2012 CPT changes (22) Modifier Usage and Reimbursement (22) 2011 CPT CHANGES (19) ERx (19) Medicaid Reimbursement (19) EHR (18) PQRI (18) CMS Transmittals (17) ICD

Modifier - as the name implies these are the two digit code that modifies a service / procedure or an item under certain circumstances. Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement. Modifier are categorized into two levels 1. Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA - American Medical Association. 2. Level II Modifiers: Normally known as HCPCS Modifiers and consists of two digits (Alpha / Alphanumeric characters) in the sequence AA through VP. These modifiers are annually updated by CMS - Centres for Medicare and Medicaid Services.

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updates (17) Coding guidelines for vaccines (16) Denial Reasons (12)
Medical Coverage Guidelines (12) UHC Reimbursement guidelines (12) Diagnosis and Treatment (11) Pathophysiology (11) BCBS reimbursement guidelines (9) List of all Modifiers (8) Reimbursement guidelines (8) Teaching Physician (7) Aetna reimbursement guidelines (6) CPT categories (6) Laboratory Procedures (6)

Both the above levels of Modifiers are recognized nationally. List of Level I Modifiers: Modifier -21 Prolonged Evaluation and Management Services (Deleted, please use CPT 99354- 99359) Modifier -22 Unusual Procedural Services Modifier -23 Unusual Anesthesia Modifier -24 Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service Modifier -26 Professional Component Modifier -27 Multiple Outpatient Hospital E/M Encounters on the Same Date. Modifier -29 Global procedures, those procedures where one provider is responsible for both the professional and technical component. This modifier has been deleted. If a provider is billing for a global service, no modifier is necessary. Modifier -32 Mandated Services Modifier -33 Preventive Service Modifier -47 Anesthesia by Surgeon Modifier -50 Bilateral Procedure Modifier -51 Multiple Procedures Modifier -52 Reduced Services Modifier -53 Discontinued Procedure Modifier -54 Surgical Care Only Modifier -55 Postoperative Management Only Modifier -56 Preoperative Management Only Modifier -57 Decision for Surgery Modifier -58 Staged or Related Procedure or Service by the Same

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Physician During the Postoperative Period Modifier -59 Distinct Procedural Service
BLOG A RCHIV E

Modifier -62 Two Surgeons Modifier -63 Procedure Performed on Infants less than 4kg

TOTA L PA GE V IE WS

Modifier -66 Surgical Team Modifier -73 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia

FEE DJIT

Modifier -74 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia Modifier -76 Repeat Procedure by Same Physician Modifier -77 Repeat Procedure by Another Physician Modifier -78 Return to the Operating Room for a Related Procedure During the Postoperative Period Modifier -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period Modifier -80 Assistant Surgeon Modifier -81 Minimum Assistant Surgeon Modifier -82 Assistant Surgeon (when qualified resident surgeon not available) Modifier -90 Reference (Outside) Laboratory Modifier -91 Repeat Clinical Diagnostic Laboratory Test Modifier -92 Alternative Laboratory Platform Testing Modifier -99 Multiple Modifiers List of Level II Modifiers: AA Anesthesia services personally performed by anesthesiologist. AD Medical supervision by a physician: More than 4 concurrent anesthesia procedures. AE Registered Dietician AF Specialty Physician

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AI Principal Physician of Record AJ Clinical Social Worker AK Non Participating Physician AM Physician, team member service AP Determination of refractive state was not performed in the course of diagnostic ophthalmological examination. AQ Service performed in a Health Professional Shortage Area AR Physician providing services in a physician scarcity area AS Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant-at-surgery, non-team member. AT Acute treatment (chiropractic claims) - This modifier should be used when reporting CPT codes 98940, 98941, 98942 or 98943 for acute treatment. AX Item furnished in conjunction with dialysis services AY Item or service furnished to an ESRD patient that is not for the treatment of ERSD AZ Physician providing a service in a dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive Payment A1 Dressing for one wound A2 Dressing for two wounds A3 Dressing for three wounds A4 Dressing for four wounds A5 Dressing for five wounds A6 Dressing for six wounds A7 Dressing for seven wounds A8 Dressing for eight wounds

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A9 Dressing for nine or more wounds BA Item furnished in conjunction with parenteral enteral nutrition (PEN) services BL Special Acquisition of blood and blood products CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission. CB Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit. CC Procedure code change- CARRIER USE ONLY - Used by carrier to indicate that the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed. Automated Multi-Channel Chemistry (AMCC) Tests Modifiers Effective date: Claims processed on or after April 5, 2010 CD AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable. CE AMCC tests has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity. CF AMCC tests has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable. Reference: http://www.cms.gov/MLNMattersArticles/downloads /MM6683.pdf CR Catastrophe/Disaster Related CS Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities. DA Oral health assessment by a licensed Health Professional other than a dentist EA Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy. EB Erythropetic stimulating agent (ESA) administered to treat anemia

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due to anti-cancer radiotherapy. EC Erythropetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy. ED Hematocrit level has exceeded 39% (or Hemoglobin level has exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle EE Hematocrit level has not exceeded 39% (or Hemoglobin level has not exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle. E1 Upper left, eyelid E2 Lower left, eyelid E3 Upper right, eyelid E4 Lower right, eyelid EJ Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab. EM Emergency reserve supply (for ESRD benefit only) ET Emergency treatment - Use to designate a dental procedure performed in an emergency situation. FA Left hand, thumb F1 Left hand, second digit F2 Left hand, third digit F3 Left hand, fourth digit F4 Left hand, fifth digit F5 Right hand, thumb F6 Right hand, second digit F7 Right hand, third digit F8 Right hand, fourth digit F9 Right hand, fifth digit FB Item provided without cost to provider, supplier or practitioner, or credit received for replaced device (examples, but not limited to

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covered under warranty, replaced due to defect, free samples) FC Partial credit received for replaced device G7 Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening GA Waiver of liability statement on file - Use to indicate that the physician's office has a signed advance notice retained in the patient's medical record.The notice is for services that may be denied by Medicare. GC This service has been performed in part by a resident under the direction of a teaching physician. GD Units of service exceeds medically unlikely edit value and represents reasonable and necessary services. GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception. GG Diagnostic Mammography - Use to indicated performance and payment of a screening mammography and diagnostic mammography on same patient, on the same day. GH Diagnostic mammogram converted from screening mammogram on same day GJ Opted Out physician or practitioner - Use to indicate services performed in an emergency or urgent service. GM Multiple patients on one ambulance trip GN Services delivered under an outpatient speech language pathology plan of care. GO Services delivered under an outpatient occupational therapy plan of care. GP Services delivered under an outpatient physical therapy plan of care. GQ Telehealth services via asynchronous telecommunications system GR This service was performed in whole or in part by a resident in a department of Veterans Affairs Medical Center or clinic supervised in accordance with VA policy. GS Dosage of EPO or Darbepoietin Alfa has been reduced and maintained in response to hematocrit or hemoglobin level.

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GT Telehealth services via interactive audio and video telecommunication systems GU Waiver of liability statement issued as required by a payer policy, routine notice GV Attending physician not employed or paid under agreement by the patient's hospice provider. GW Service not related to the hospice patient's terminal condition. GY Use to indicate when an item or service statutorily excluded or does not meet the definition of any Medicare benefit. GZ Use to indicate when an item or service expected to be denied as not reasonable and necessary.Used when no Advanced Beneficiary Notice (ABN) signed by the beneficiary. J1 Competitive Acquisition Program, no-pay submission for a prescription number J2 Competitive Acquisition Program, restocking of emergency drugs after emergency administration J3 Competitive Acquisition Program, (CAP) drug not available through CAP as written, reimburse under ASP Methodology JA Administered intravenously JB Administered subcutaneoulsly JC Skin substitute used as a graft JD Skin substitute NOT used as a graft KB Beneficiary requested upgrade for ABN, more than 4 modifiers identified on claim KC Replacement of special power wheelchair interface KD Drug or Biological infused through implanted DME KE Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment KF Item designated by FDA as Class III device KM Replacement of facial prosthesis - including new impression/moulage KN Replacement of facial prosthesis - Using previous master model

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KX Specific required documentation on file (used for DMERC providers) KZ New Coverage not implemented by managed care LC Left circumflex coronary artery LD Left anterior descending coronary artery LR Laboratory Round Trip. LT Left Side - Used to identify procedures performed on the left side of the body. M2 Medicare Secondary Payer NB Nebulizer system, any type, FDA-Cleared fo ruse with specific drug NU New equipment (DME) P1 A normal healthy patient P2 A patient with mild systemic disease P3 A patient with severe systemic disease P4 A patient with severe systemic disease that is a constant threat to life P5 A moribund patient who is not expected to survive without the operation P6 A declared brain-dead patient whose organs are being removed for donor purposes PA Surgery Wrong Body Part PB Surgery Wrong Patient PC Wrong Surgery on Patient Please refer http://www.cms.hhs.gov/MLNMattersArticles/downloads /MM6718.pdf for proper usage of PA, PB and PC Modifiers PD - Diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or 1 day. (New modifier for the year 2012, Check for Usage and reimbursement)

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PI PET Tumor init tx strategy PS PET Tumor subsq tx strategy PT Colorectal cancer screening test; converted to diagnostic test or other procedure Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study. Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study. Q3 Liver Kidney Donor Surgery and Related Services. Q4 Service for ordering/referring physician qualifies as a service exemption Q5 Service furnished by a substitute physician under a reciprocal billing arrangement Q6 Service furnished by a locum tenens physician Q7 One CLASS A finding Q8 Two CLASS B findings Q9 One CLASS B and two CLASS C findings QA FDA Investigational device exemption (IDE) - The IDE project number must be included on the claim when modifier QA is billed. QB Physician service in a rural HPSA. QC Single channel monitoring. QD Recording and storage in solid state memory by a digital recorder. QJ Services/items provided to a prisoner or patient instate or local custody. QK Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals. QL Patient pronounced dead after ambulance called QM Ambulance service provided under arrangement by a provider of services QN Ambulance service furnished directly by a provider of services

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QP Panel test - Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes. QS Monitored anesthesia care QT Recording and storage on tape by an analog tape recorder. QU Physician service in an urban HPSA. QV Item or service provided as routine care in a medical qualifying clinical trial QW CLIA Waived Test - Effective October 1, 1996, all new waived tests are being assigned a CPT code (in lieu of a temporary five-digit G- or Q-code). QX CRNA service with medical direction by physician. QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist. QZ CRNA service without medical direction by a physician. RA Replacement of a DME item, Orthotic or Prosthetic Item RB Replacement of a Part of DME, Orthotic or Prosthetic Item furnished as Part of a Repair RC Right coronary artery RD Drug provided to beneficiary, but not, administrated incident-to RE Furnished in full compliance with FDA-Mandated Risk Evaluation and Mitigation Strategy (REMS) RP Replacement and repair RT Right Side - Used to identify procedures performed on the right side of the body. RR Rental (use the RR modifier when DME is a rental) SC Medically necessary service or supply (w.e.f Jan 1, 2012) SF Second opinion ordered by a Professional Review Organization (PRO) per section 9401, P.L. 99-272 (100 % reimbursement no Medicare deductible or coinsurance) SG Ambulatory Surgical Center (ASC) modifier

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SK Member of high risk population (Use only with codes for immunization) SS Home infusion services provided in the infusion suite of the IV therapy provider SW Services provided by a certified diabetes educator TA Left foot, great toe T1 Left foot, second digit T2 Left foot, third digit T3 Left foot, fourth digit T4 Left foot, fifth digit T5 Right foot, great toe T6 Right foot, second digit T7 Right foot, third digit T8 Right foot, fourth digit T9 Right foot, fifth digit TC Technical component only - Use to indicate the technical part of a diagnostic procedure performed. TS Follow-up service UE Used durable medical equipment UN Portable X-ray Modifiers; two patients UP Portable X-ray Modifiers; three patients UQ Portable X-ray Modifiers; four patients UR Portable X-ray Modifiers; five patients US Portable X-ray Modifiers; six patients V1 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to a "minimal" level. V2 Level of MMI for Treating Doctor - This modifier would be added

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to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "self limited or minor" level. V3 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "low to moderate" level. V4 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "moderate to high severity" level and of at least 25 minutes duration. V5 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "moderate to high severity" level and of at least 45 minutes duration. V5 Any Vascular Catheter (alone or with any other vascular access) Part A only modifier V6 Arteriovenous Graft (or other vascular access not including a vascular catheter) - Part A only modifier V7 Afteriovenous Fistula (or other vascular access not including a vascular catheter) - Part A only modifier V8 Dialysis related infection present during the billing month - Part A only modifier V9 No dialysis related infection present during the billing month - Part A only modifier VR Review report - This modifier shall be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 to indicate that the service was the treating doctor's review of report(s) only. Modifier ZA (Anesthesia modifier especially used for Medi-cal insurance of California) denotes prone position or surgical field avoidance. To be used only for procedures that have a base value of three (3) units. These techniques are included in the anesthesia base value of surgical procedures with a base value of more than three. Modifier ZE (Anesthesia modifier especially used for Medi-cal insurance of California) To be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a Certified Registered Nurse Anesthetist (CRNA).

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Please note: It is also necessary to check the respective insurance guidelines for appropriate usage of Modifiers to avoid denials.
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LIST OF MODIFIERS Modifier - as the name implies these are the two digit code that modifies a service / procedure or an item under certain circumstances. M... 2012 New modifiers Medicare HCPCS modifier PD will be available to wholly owned or wholly operated entities beginning January 1, 2012 and may be appended to P... 2011 CPT CODE CHANGES Also see the list of new and Deleted CPT codes effective for the year 2012 Evaluation and Management 3 New Codes 99224 - Subseque... Global Period Global Period is a time frame following surgery during which routine care by the physician i.e., all necessary services normally furnished b... 2012 New & Deleted CPT codes - Integumentary system Integumentary System For CY 2012, the CPT Editorial Panel deleted 24 skin substitute codes and established a 2-tier structure with 8 new ... 2012 CPT code changes for Cardiology "CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association." C... 2012 CPT codes changes Radiology codes additions and Deletions 74174 Computed tomographic angiography, abdomen and pelvis; with contrast material(s), includin... 2012 CPT code updates for Respiratory System Newly added CPT code list 32096 Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral 3209... 2012 ICD 9 CM CHANGES - INVALID DIAGNOSIS CODES Effective from October 1, 2011 The invalid ICD 9 CM diagnosis codes w.e.f October 1 2011 includes Malignant Neoplasm codes and few V-codes. A complete update of Invalid I... After hours and Weekend care CPT codes 99050, 99051, 99053, 99056, 99058 and 99060 - Reimbursement Americhoice insurance The Centers for Medicare and Medicaid Services (CMS) considers reimbursement for Current Procedural Terminology ...

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hookah

(noun) An oriental tobacco pipe with a long flexible tube connected to a container where the smoke is cooled by passing through water. Synonyms: calean, chicha, hubble-bubble, kalian, narghile, shisha, water pipe Usage: Though I constantly lecture him about the dangers of smoking, my Iranian grandfather refuses to get rid of his hookah.

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