question

Anesthesia by surgeon--Modifier 47

answer

used only by physicians or surgeons when regional or general anesthesia is provided by the same physician or surgeon who is completing the procedure or service

question

Assistant surgeon--Modifier 80

answer

used to indicate that one surgeon was in the operating room to assist the primary surgeon room to assist the primary surgeon

question

Assistant surgeon (when a qualified resident surgeon is not available in a teaching facility)--Modifier 82

answer

used when there is the unavailability of a qualified resident surgeon

question

Bilateral procedure--Modifier 50

answer

bilateral procedures performed in the same operative session

question

CPT Modifier

answer

two-digit code that is appended to the CPT code to indicate that a service or procedure has been altered for some reason, but main definition of the code has not changed

question

Decision for surgery--Modifier 57

answer

append to an evaluation and management service code when, during the service, the initial decision was made to perform surgery

question

Discontinued outpatient hospital/ASC procedure after administration of anesthesia--Modifier 74

answer

used when, due to extenuating circumstances or those that threaten the well-being of the patient, the physician terminates a surgical or diagnostic procedure after the administration of anesthesia or after the procedure was started

question

Discontinued outpatient procedure prior to anesthesia administration--Modifier 73

answer

used for outpatient ambulatory surgery centers and used when, due to extenuating circumstances or situation that threatens the well-being of the patient, the physician decides to cancel the surgery or diagnostic procedure subsequent to the patient's surgical preparation

question

Discontinued procedure--Modifier 53

answer

physician may terminate a surgical or diagnostic procedure because of extenuating circumstances that threaten the well-being of the patient

question

Informational Modifier

answer

used for informational purposes and has an impact on the processing or payment of the code billed but does not affect the fee

question

Mandated services--Modifier 32

answer

used if services are performed because the service is required or mandated by a peer review organization, insurance company, governmental, legislative, or regulatory agency

question

Minimum assistant surgeon--Modifier 81

answer

used if the circumstances required a second surgeon for a short period of time, but not throughout the whole procedure

question

Modifier 22

answer

increased procedural service; service provided greater than that usually required for listed procedure

question

Modifier 23

answer

unusual use of general anesthesia

question

Modifier 24

answer

unrelated E/M service, same physician, during postoperative period

question

Modifier 25

answer

significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service

question

Modifier 26

answer

professional component; physician reports only the professional component of a service rendered

question

Modifier 32

answer

mandated services; required or mandated by a peer review organization, insurance company, governmental, legislative, or regulatory agency

question

Modifier 47

answer

anesthesia by surgeon when regional or general anesthesia is provided by the same physician or surgeon who is performing the procedure or service

question

Modifier 50

answer

bilateral procedure

question

Modifier 51

answer

multiple procedures; additional procedure(s) or service(s) would be reported with this modifier; not used by facilities

question

Modifier 52

answer

reduced services; procedure is partially reduced or eliminated at the physician's discretion

question

Modifier 53

answer

discontinued procedure; termination of a surgical or diagnostic procedure because of extenuating circumstances that threaten the well-being of the patient

question

Modifier 54

answer

surgical care only

question

Modifier 55

answer

postoperative management only

question

Modifier 56

answer

preoperative management only

question

Modifier 57

answer

decision for surgery

question

Modifier 58

answer

staged or related procedure or service by the same physician during the postoperative period

question

Modifier 59

answer

distinct procedural service

question

Modifier 62

answer

two surgeons; two primary surgeons work together to perform distinct parts of a single reportable procedure

question

Modifier 63

answer

procedure performed on infants less than 4 kg

question

Modifier 66

answer

surgical team; several physicians of different specialties, other highly skilled and specially trained personnel, and various types of complex equipment used during the operative procedure

question

Modifier 73

answer

discontinued outpatient hospital/ASC procedure prior to the administration of anesthesia

question

Modifier 74

answer

discontinued outpatient hospital/ASC procedure after administration of anesthesia

question

Modifier 76

answer

repeat procedure by same physician

question

Modifier 77

answer

repeat procedure by another physician; basic procedure or service performed by another physician had to be repeated

question

Modifier 78

answer

unplanned return to the operating room for a related procedure during the postoperative period

question

Modifier 79

answer

unrelated procedure or service by the same physician during the postoperative period

question

Modifier 80

answer

assistant surgeon

question

Modifier 81

answer

minimum assistant surgeon

question

Modifier 82

answer

assistant surgeon when qualified resident surgeon is not available in a teaching facility; used in a teaching hospital setting residency program

question

Modifier 90

answer

reference outside laboratory; laboratory procedures are performed by a party other than the treating or reporting physician

question

Modifier 91

answer

repeat clinical diagnostic laboratory test

question

Modifier 99

answer

indicates multiple modifiers are needed for an individual CPT code

question

Multiple modifiers--Modifier 99

answer

used to report more than four modifiers were necessary to completely delineate a service

question

Multiple procedures--Modifier 51

answer

multiple procedures are performed at the same session by the same provider

question

Postoperative management only--Modifier 55

answer

indicates that one provider performed the postoperative management and another provider performed the surgical procedure and/or preoperative management

question

Preoperative management only--Modifier 56

answer

indicates that one provider performed the preoperative management and another provider performed the surgical procedure and/or postoperative management

question

Pricing Modifier

answer

either increases or decreases the fee for the service

question

Professional component--Modifier 26

answer

only the professional component being reported by the physician

question

Reduced services--Modifier 52

answer

used when procedure is partially reduced or eliminated at the physician's discretion

question

Reference (outside) laboratory--Modifier 90

answer

used on laboratory procedure codes to indicate that the laboratory procedures are performed by a party other than the treating or reporting physician

question

Repeat clinical diagnostic laboratory test--Modifier 91

answer

used to indicate that the same laboratory test was repeated on the same day to obtain subsequent (multiple) test results

question

Repeat procedure by another physician--Modifier 77

answer

used when the basic procedure or service performed by another physician has to be repeated

question

Repeat procedure by same physician--Modifier 76

answer

repeat the procedure or service that was rendered at the initial surgery

question

Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service--Modifier 25

answer

added to any appropriate level of an evaluation and management service when the physician needs to indicate that on the day a procedure or service was performed, the patient's condition required a significant, separately identifiable evaluation and management service that was above and beyond the other service provided

question

Staged or related procedure or service by the same physician during the postoperative period--Modifier 58

answer

used when during the original procedure a second procedure was planned as part of the care; when during postoperative period more extensive care is needed than what was rendered in the original procedure; or when during the postoperative period a diagnostic surgical procedure therapy is required

question

Statistical Modifier

answer

used for informational purposes and has an impact on the processing or payment of the code billed but does not affect the fee

question

Surgical care only--Modifier 54

answer

used when one physician performs the surgical procedure and another physician performs the preoperative and/or postoperative management

question

Surgical team--Modifier 66

answer

procedure(s) that requires the services of several physicians

question

Two surgeons--Modifier 62

answer

used when two primary surgeons work together to perform distinct parts of a single reportable procedure

question

Unplanned return to the operating room for a related procedure during the postoperative period--Modifier 78

answer

unplanned procedure following initial procedure

question

Unrelated evaluation and management service by the same physician during postoperative period--Modifier 24

answer

used when a patient is seen for an unrelated evaluation and management service during a postoperative period

question

Unusual anesthesia--Modifier 23

answer

used when a procedure that routinely is not completed with any type of anesthesia requires the use of general anesthesia

question

Unusual procedural services--Modifier 22

answer

used when the service provided is greater than that usually required for the listed procedure

PC: Ch. 2 – Modifiers – Flashcards

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