MODIFIERS AND MODIFIER INDICATORS
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Modifiers are categorized in to Three categories mention as follows, when minor procedure is unbundled in the major procedure we have to append the below mentioned modifiers to get reimbursed from the payors to the client.
Anatomic modifiers: E1-E4, FA,
F1-F9, TA, T1-T9, LT, RT, LC, LD, RC.
Global surgery modifiers: 25, 58,
78, 79.
Other modifiers: 27, 59, 91.
Anatomic modifiers:
E1- This modifier is used to indicate upper left eye lid.
E2- This modifier is used to indicate lower left eye lid.
E3- This modifier is used to indicate upper right eye lid.
E4- This modifier is used to indicate lower right eye lid.
FA- This modifier is used to indicate thumb of left hand.
F1- This modifier is used to indicate second (index finger)of left hand.
F2- This modifier is used to indicate third digit(long finger) of left hand.
F3- This modifier is used to indicate fourth digit(ring finger) of left hand.
F4- This modifier is used to indicate fifth digit(small finger) of left hand.
F5- This modifier is used to indicate thumb of right hand.
F6- This modifier is used to indicate second digit (index finger) of right hand.
F7- This modifier is used to indicate third digit(long finger) of right hand.
F8- This modifier is used to indicate fourth digit(ring finger) of right hand.
F9- This modifier is used to indicate fifth digit(small finger) of right hand.
TA- This modifier is used to indicate great toe of left foot great toe.
T1- This modifier is used to indicate second digit of left foot.
T2- This modifier is used to indicate third digit of left foot.
T3- This modifier is used to indicate fourth digit of left foot.
T4- This modifier is used to indicate fifth digit of left foot.
T5- This modifier is used to indicate great toe of right foot.
T6- This modifier is used to indicate second digit of right foot.
T7- This modifier is used to indicate third digit of right foot.
T8- This modifier is used to indicate fourth digit of right foot.
T9- This modifier is used to indicate fifth digit of right foot.
Anatomic modifiers:
E1- This modifier is used to indicate upper left eye lid.
E2- This modifier is used to indicate lower left eye lid.
E3- This modifier is used to indicate upper right eye lid.
E4- This modifier is used to indicate lower right eye lid.
F1- This modifier is used to indicate second (index finger)of left hand.
F2- This modifier is used to indicate third digit(long finger) of left hand.
F3- This modifier is used to indicate fourth digit(ring finger) of left hand.
F4- This modifier is used to indicate fifth digit(small finger) of left hand.
F5- This modifier is used to indicate thumb of right hand.
F6- This modifier is used to indicate second digit (index finger) of right hand.
F7- This modifier is used to indicate third digit(long finger) of right hand.
F8- This modifier is used to indicate fourth digit(ring finger) of right hand.
F9- This modifier is used to indicate fifth digit(small finger) of right hand.
TA- This modifier is used to indicate great toe of left foot great toe.
T1- This modifier is used to indicate second digit of left foot.
T2- This modifier is used to indicate third digit of left foot.
T3- This modifier is used to indicate fourth digit of left foot.
T4- This modifier is used to indicate fifth digit of left foot.
T6- This modifier is used to indicate second digit of right foot.
T7- This modifier is used to indicate third digit of right foot.
T8- This modifier is used to indicate fourth digit of right foot.
T9- This modifier is used to indicate fifth digit of right foot.
A) Modifier 22: Modifier
22 is defined by the CPT Book as “Increased Procedural Services”.
For example: A pateint under went ACL reconstruction, due to pateint morbid obesity there was extra time taken for the procedure, then we have to append 22-modifier to the cpt code.
B) Modifier 25: The CPT Book defines modifier 25 as “significant,
separately identifiable evaluation and management service by the same physician
on the same day of the procedure or other service”. Modifier
25 may be append to the evaluation and management (E&M) service CPT code to indicate that the evaluation nd management( E&M) service is
significant and separately identifiable from other services reported on the
same date of services.
C) Modifier 58: Modifier 58 is defined by the CPT Book as a “Staged or related procedure or service by the same physician during the postoperative period”. It may append to indicate that one procedure is followed by the second procedure.
C) Modifier 58: Modifier 58 is defined by the CPT Book as a “Staged or related procedure or service by the same physician during the postoperative period”. It may append to indicate that one procedure is followed by the second procedure.
For example: If physician is performing laproscopy procedure after performing the procedure laproscopy fails then is decided to perform an open procedure, then laproscopic procedure should not be coded. we have to code for open procedure and should append modifier 58 to show that the second procedure is performed with the first procedure.
D) Modifier 59: Modifier 59 is an important NCCI-associated modifier. Its purpose is to indicate that two (or) more procedures are performed at different anatomic sites or different patient . The CPT Manual defines Modifier 59 as : “Distinct procedural service”. Under certain circumstances, the physician may need to indicate that a procedure was distinct or independent from other services. we can use Modifier 59 if there is no other modifer indicate the appropriate to show the procedure is distinct from the other procedure.
For example: If Lateral Menisectomy(29881) is performed with Removal of loose body from patella compartment(29874) .Then we have to append 59 modifier to 29874 to show that removal of loose body is performed in the different compartment.
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