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Medical Billing

Modifiers

QuestionAnswer
Modifier -22 Unusual Services: When the service(s) provide is substantially greater than that usually required for the listed procedure, it may be identified by adding modifier.
Modifier -23 Unusual Anesthesia: Occasionally a procedure that usually requires either no anesthesia or local anesthesia must be done under general anesthesia because of unusual circumstances.
Modifier -24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s).
Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the same Physician on the Same Day of a Procedure or Other Service.
Modifier -26 Professional Component: Certain procedures are a combination of a physician component and technical component.
Modifier -32 Mandated Services: Services related to mandated consultation and/or related services may be identified by adding the modifier.
Modifier -33 Preventive Services: When the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive ser.mandates.
Modifier -47 Anesthesia by Surgeon: Regional or general anesthesia provided by the surgeon may be reported by adding the modifier.
Modifier -50 Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by the appropriate 5-digit code # describing the 1st procedure. 2nd proced. is by adding modifier.
Modifier -51 Multiple Procedures: When multiple procedures other that E/M services are performed at the same session by the same provider, the primary procedure or service may be reported as listed.
Modifier -52 Reduced Services: Under certain circumstances, a services or procedure is partially reduced or eliminated at the physician's descretion.
Modifier -53 Discontinued Procedure: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure.
Modifier -54 Surgical Care Only: When one physician performs surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier.
Modifier -55 Postoperative Management Only: When on physician performs the postoperative management and another physician performs the surgical procedure , the postoperative component may be identified by adding the modifier.
Modifier -56 Preoperative Management Only: When one physician performs the preoperative care and evaluation and another physician performs the surgical procedure, the preoperative component may be identified by adding the modifier.
Modifier -57 Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding the modifier.
Modifier -58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period.
Modifier -59 Distinct Procedural Service.
Created by: rochelle1977