MODIFIERS

1
MODIFIERS

• Presented by
• Joan Benham, CPC, CPC-H
• Institutional Compliance Program

2
Learning about Modifiers.

• Definition of Modifiers
• Purpose of Modifiers
• Types of modifiers
• Proper use of Modifiers

3

LT
59
T4

• Modifiers are two-five numeric or alpha-numeric
  characters appended to the end of a CPT or HCPCS
  Level 2 or 3 code
• Example 99213-25
• 99213-09925

F1
GC
58
4
Types of Modifiers

• HCPCS Level I - CPT
• HCPCS Level II - National
• HCPCS Level III - Local
• Hospital

5
Why modifiers?????

• Modifiers were designed to provide
• payers additional information needed to
• process a claim

6
Reasons to use modifiers..

• Bilateral procedures - 50
• Repeat procedure same day- 76 or 77
• Staged procedure - 58
• Right or left side - RT or LT
• Two surgeons - 62
• Decision for surgery - 57

7
Things to know about modifiers

• HCPCS modifiers can be used with CPT codes
• CPT modifiers are found in Appendix A
• Modifiers are specific in nature and are not
  used with all codes
• Some modifiers are informational in nature

8
Using modifiers...

• Appended at the end of the code
• You can use multiple modifiers
• The CPT modifier always goes first
• Examples 99201-25-GC
• 28290-22-T1

9
Documentation required

• Modifier 22 - Unusual services
• Modifier 52 - Reduced services
• Modifier 62 - Two surgeons
• Modifier 66 - Surgical Team

10
Deciding which modifier to use

11
Misuse of modifiers.

• Modifier 25
• Modifier 62
• Modifier GC

12
Resources ..

• Medicare Physician Fee Schedule Database
• www.hcfa.gov/stats/cpt/rvudown.htm
• Medicaid Manual Level III Modifiers
• Modifiers Made Easy (St. Anthonys)