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Modifiers
Physical Status
| Question | Answer |
|---|---|
| A normal healthy patient? | P1 |
| A patient with mild systemic disease? | P2 |
| A declared brain-dead patient whose organs are being removed for donor purposes? | P6 |
| A patient with severe systemic disease? | P3 |
| A moribund patient who is not expected to survive without the operation? | P5 |
| A patient with severe systemic disease that is a constant threat to life? | P4 |
| Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding ____? | Modifier 22 (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental) |
| Unusual Anesthesia: Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances may be reported by | Modifier 23 |
| Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period. | Modifier 24 |
| Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | Modifier 25 |
| Professional Component: When the physician or other qualified care professional component is reported separately, (ie, X-rays, radiologist services other than that physician). | Modifier26 |
| Mandated Services: Services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding ? | Modifier 32 |
| Bilateral Procedure: Unless otherwise identified in the listings. bilateral procedures that are performed at the same session, should be identified by adding --- to the appropriate 5 digit code. | Modifier 50 |
| Multiple Procedures: When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (eg. vaccines) are performed at the same session by the same individual, the primary procedure or service | Modifier 51 (may be reported as listed) |
| Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. | Modifier 52 |
| Discontinued Procedure: Under certain circumstances, the physician or other qualified health care professional ma elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient. | Modifier 53 (it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued). |
| Surgical Care Only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and /or postoperative management, surgical services may be identified by adding? | Modifier 54 |
| Postoperative Management Only: When 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding? | Modifier 55 |
| Preoperative Management: When 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding? | Modifier 56 |
| Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier? | Modifier 57 |
| Distinct Procedure Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. | Modifier 59 Used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. |
| Two Surgeons: When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding? | Modifier 62 |
| Procedures Performed on Infants less than 4kg: Procedures performed on neonates and infants up to 4kg may involve significantly increased complexity and physician or other qualified health care professional work commonly associated with these patients. | Modifier 63 (Note: Unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20100-69990 code series) |
| Multiple Modifiers: Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. (Example: 00100-P1). | Modifier 99 Under certain circumstances, when another established modifier (s) is appropriate, it should be used in addition to the physical status modifier. |
Created by:
MissMeeMee
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