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College of Medicine Office of Compliance, Gainesville, Florida
COMPLIANCE TIP -
Common CPT ModifiersSome of the common CPT Modifiers
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) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service.
Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
The patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. Different diagnoses are not required. *Not to be used to report E/M service that resulted in decision for major surgery (Modifier 57).
Modifier 51 - Multiple Procedures
When multiple procedures, other than E/M services, are performed at the same session by the same provider, the primary procedure or service is reported as listed. The additional procedure(s) or service(s) may be identified by appending the modifier 51 to the additional procedure or service code(s). Some procedures are Modifier 51 exempt. Check the CPT book for procedures particular to specialty which may be "51 Exempt.
Modifier 52 - Reduced Services
Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.
Modifier 53 - Discontinued Procedure
Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the physician for the discontinued procedure.
Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite.
Modifier 57 - Decision for Surgery
An evaluation and management service that resulted in the initial decision to perform major surgery may be identified by adding modifier 57 to the appropriate level of evaluation and management service. This modifier applies only to major surgical procedures and is used with the evaluation and management service provided the day before or the day of a major procedure.
Modifier 58 - Stage or Related Procedure or Service by the Same Physician During the Postoperative Period
It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure.
Modifier 59 - Distinct Procedural Service
Service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Modifier 59 allows for bypassing bundling issues (CCI edits). Documentation must support a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury not ordinarily encountered or performed on the same day by the same physician.
Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure.
Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
The physician may need to indicate that the performance of a procedure or service during a postoperative period was unrelated to the original procedure.
GC Modifier - Identifies services that have been performed in part by a resident/fellow under the direction of a teaching physician.
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