HCPCS modifiers are level:
If a patient requests a second opinion, modifier 32 may be used
Modifiers 76 and/or 77 are used to:
When using modifier 80, assistant surgeon, the primary surgeon must use:
The main difference between modifier 80 and modifier 81 is:
If a procedure must be performed because of complication of a previous surgery and is performed during the global surgical period, the correct modifier to append to the procedure code is:
Guidelines for billing an E/M visit and a procedure on the same date of service include:
Modifiers 54 and 55 are often used:
Modifier 24 should always be used with:
The portion of a test or procedure that the physician performs (reading an X ray, EKG and so on) is known as the :
A national uniform coding structure developed by the Centers for Medicare and Medicaid for reporting physician/supplier services for government programs is known as:
A patient returning within the global surgical time frame for a mole excision presents to the physician’s office for Evaluation of headache. Which modifier should be attached?
After a consultation for a new patient, the surgeon decided to operate on the patient the same day. The procedure is a major procedure with a 90 day global surgical time frame and the patient’s insurance company is a third party payer. What modifier is appended to the consultation code?
Modifier 51 and 59 may be appended to an add-on code
An established patient presents with uterine bleeding, hysteroscopy with endometrial biopsy is performed; the patient is also evaluated for a breast cyst. The breast evaluation consists of an expanded problem-focused history and physical exam and medical decision making of low complexity.
A 16-year-old female presented for an intravenous pyelography with KUB and tomography. During the procedure, the patient complained of shortness of breath and nausea. There did not appear to be an allergic reaction, so the procedure was cautiously continued. The patient was extremely apprehensive and the procedure was prolonged by 70 minutes beyond its usual duration.
Insurance company requires a second opinion for a patient with a congenital medullary sponge kidney requiring pyelotomy (50120). The consultation includes a comprehensive history and examination with moderate complexity decision-making.
Patient had to have the left hand amputated at the metacarpal. Three days status post surgery, the wound became infected, resulting in a return to the operating room for extensive debridement of the skin, subcutaneous tissue, and muscle. Since the physician is within the global period for the amputation, it is necessary to report the second service with a modifier.
A Medicare patient was seen by a urologist on Monday. Based on the detailed examination and moderate complexity decision making, it was determined that the patient has a stricture of the ureter requiring surgical intervention pyeloplasty (global period - 90 days). The patient was scheduled for surgery on Tuesday.
A laboratory test is rerun due to malfunction of the equipment. Use modifier:
Of the Modifiers below, which would you consider the "opposite" of modifier 22?
If the patient undergoes an appendectomy on June 8th then a cholecystectomy is performed on august 16th by the same surgeon what modifier would be placed on the cholecystectomy code with in the post operative period?
The postoperative care only for a radical mastectomy including pectoral muscles, axillary and internal mammary lymph nodes
Mrs. Knight has a diagnostic surgical biopsy of deep cervical lymph nodes on May 8 and the pathology report comes back showing malignancy. Mrs. Knight elects to have a lymphadenectomy on May 11. What modifier would be used with the lymphadenectomy code?
The Patient was seen for an office visit because of a urinary tract infection. The visit involved an expanded problem focused exam and low complexity decision making. Three weeks ago the patient underwent surgical intervention to correct an abnormal curvature of the penis (54360).
Modifier -50, Bilateral Procedure, is used when:
If a procedure is complicated by the late effects of a previous surgery, irradiation, infection or vey low birth weight (and there is not a separate CPT code to identifying these:
When using modifier 51 it is recommended that:
If a patient elects to cancel a procedure before it takes place, then the use of modifier -53 would be appropriate:
The modifier that identifies the physician component.
Using anesthesia procedure codes 00100-01999, code general anesthesia for repair of ruptured aortic aneurysm with graft. The patient was noted to have severe systemic disease at the time of the anesthesia, and a pump oxygenator was used during the procedure.
A patient underwent a percutaneous needle core biopsy of the left breast with omaging guidance. The specimen was sent to pathology and the findings indicated a malignancy. The next morning the patient was taken to surgery and a partial mastectomy with removal of lymph nodes was performed on the left breast. Select the appropriate code for the second procedure.
A second opinion regarding surgery was required by the insurance company to assure maximum reimbursement for the performing physician. The patient was seen in the physician’s office. The following key components were performed: office. The following key components were performed: comprehensive history and examination with moderate complexity medical decision making.
Code for the following arthroscopy, knee, surgical, with synovectomy, limited, in the medial compartment, and with lateral menisectomy.
What modifier indicates that a bilateral procedure was performed?
Modifier 54 and 55 are often used:
Modifier 24 should always be used with:
Payment using modifier 51 may be impacted by:
The portion of a test or procedure that the physician performs (reading an X ray, EKG, and so on) is known as the:
A national uniform coding structure developed by CMS for reporting physician/supplier services for government programs is known as:
A patient returning within the global surgical time frame for a mole excision presents to the physician’s office for follow up treatment. Which modifier should be attached?
After a consultation for a new patient, the surgeon decided to operate on the patient the same day, the procedure is a major procedure with a 90-day global surgical time frame and the patient’s insurance company is a third-party payer. What modifier is appended to the consultation code?
The modifier used to indicate that a procedure is less extensive that the description given in CPT is 53.
The modifier that indicates that surgical care only was provided for a procedure is modifier 55.
An insurance carrier requires a patient to obtain a second opinion before approving a surgical procedure. Modifier 22 would be used to indicate that this was a mandated service.
If a patient had multiple procedures during the same operative session, modifier 51 is added to the lesser of the two codes.
Modifier 55 is used to indicate only the preoperative management of the patient.
CPT modifiers are published by:
It is always incorrect to use modifier 51 with a codes listed in Appendix D.
Modifier 23 is the modifier used to report anesthesia services performed by the surgeon.
Modifier 51 and 59 may be appended to an add-on code.
Modifier 47 is used by the physician-not the anaesthesiologist-who provides regional or general anaesthesia during a surgical procedure; the modifier is attached to the appropriate anaesthesia code.
Modifier 25 may be used with the E/M service when a surgical procedure is the only service provided to a patient on the same day.
The two-digit modifier 57 means:
When coding for X-ray films taken of both knees:
Modifier 73 and 74 are most appropriate in:
The main difference between modifier 80 and 81 is:
Modifier 90 is used to indicate that although the physician is reporting the performance o a laboratory test , the actual testing component was a service from a laboratory.
If surgeons of different specialties are each performing a different procedure (with specific CPT codes), neither co-surgery nor multiple surgery rules apply even if the procedure(s) are performed through the same incision.
Modifier 59 is not designed to provide reimbursement for separate procedures that are performed as an integral part of another procedure and is watched closely by carriers.
A physician performed an internal and external destruction of haemorrhoids on a patient during a 90-day follow-up period for a second (staged)destruction procedure in regard to infrared coagulation of haemorrhoids.
A primary care physician performed chest X ray and observes a suspicious mass. He sent the patient to a pulmonologist who, on the same day, repeated the chest X ray.
A full-thickness graft was performed 10 days following an allograft application of pigskin to allow the underlying tissues time to heal. The surgeon knew at the time of the allograft that grafting would be performed at a later date. Provide the procedure and modifier for the graft.
A 46-year-old patient with a history of seizure disorder, and who was taking Phenobarbitol for seizure control, went to the lab to have her blood drawn to measure the Phenobarbitol level to determine if the dosage was providing proper therapeutic value. She had her blood drawn prior to taking the drug in the morning. In the afternoon, the patient had the lab redrawn to determine if the level in the afternoon was providing appropriate seizure control.
An orthopaedic surgeon performed an arthroscopy on the right knee for the loose body removal. One week later ( during the postoperative period), the patient tripped and fell, and the fractured the right radial shaft. The orthopaedic surgeon who performed the arthroscopy was contacted and performed a closed manipulation of the radial shaft and applied a short arm cast.
A 66-year-old patient suffered a right ankle injury while attempting to clear a sidewalk of snow. The patient presented to the emergency department where the emergency room physician ordered ankle films, three views. After reviewing the X rays, the physician applied a short leg splint (calf to foot) and advised the patient to see his family physician in 10 days.
A 60-year-old male with an enlarged spleen and past history of Hodgkin disease presented to the emergency room. After the ER physician examined the patient, the ER physician contacted the patient’s physician (surgeon) who came down to the ER to see the patient. The surgeon evaluated the patient and performed a comprehensive history and examination with high complexity decision making and determined the patient needed an immediate splenectomy. Once the decision was made to operate, the surgeon reviewed laboratory and X ray/imaging studies to plan the operative approach, discussed the procedure with the patient, and obtained informed consent. Medical and anaesthesiology consults are requested. At operation, a subcostal incision was performed , the spleen mobilised and the vessels doubly ligated. Postoperatively, the wound was monitored for infection and injectable pain medications were tapered as tolerated. The patient was discharged from the hospital when stable and comfortable an oral pain medications.
A 20-year-old patient, who was having trouble hearing out of her left ear, underwent a screening test (pure tone, air only) in her left ear.
A patient required arthroplasty of the tibial plateaus of both knees. Code this procedure for the surgeon.
A patient presented to the operating room for a diagnostic arthroscopy of the knee. The physician inserted the arthroscope and the patient suddenly went into respiratory distress. The arthroscope was withdrawn and the procedure was terminated.
A physician performed a laminotomy with decompression of the nerve root with a partial factetectomy, foraminotomy, and/or excision of a herniated disk. During the surgery the physician encountered excessive bleeding (hemorrhage) that required an additional 60 minutes of time to complete the surgery.
An established patient presented with a 2.0-cm laceration of the right index finger . while there, the patient asked the physician to evaluate swelling of the left leg, and ankle and an expanded problem-focused history and physician (H&P) with low medical decision making was performed for this problem.
The surgeon initiated a regional Bier Block. The physician monitored the patient and block while performing a flexor tendon repair of the forearm.
Attempted to excise vascular malformation of the hand, deep. Unable to completely excise secondary to entrapment of other structures.
How is a bilateral tubal ligation reported?
Two different lesions of the left breast were excised through two separate incisions. Select the appropriate procedure code(s).
A patient presented to radiology for an upper gastrointestinal series with a kidney-ureter-bladder study, but because of equipment failure, the procedure was cancelled and rescheduled. Which of the following should ne coded?
A 5-year-old male was taken to the ER at the local hospital. The child had swallowed lead paint that had peeled from a bedroom in his babysitter’s house. A lead toxicity test was performed immediately, and the patient was started on IV infusion of detoxification agent. Three hours later, a lead test was repeated to determine if the IV infusion was reducing the level of lead in the patient’s blood. How should these lab services be reported?
A surgeon performed a liver biopsy on a 6-week-old, 3.5kg neonate with a 2 week history of cholestasis. The biopsy was performed to differentiate between biliary atresia and other causes of neonatal hepatitis.
A 69-year-old car accident victim was rushed to the emergency department of a local hospital. The ED physician determined that the patient had a hip dislocation. An orthopaedic surgeon saw the patient and decided to perform the surgery that evening because the patient was in so much pain. What modifier would be used?
A patient had an angioma removed from the face, which created a deep defect. The patient returned to the surgeon 4 weeks later for a repair. The physician repaired the 3.5-cm defect by means of a complex closure. What modifier is appended to the secondary procedure?
A surgeon attempted to excise a deep vascular malformation of the hand. The surgeon was unable to completely excise it secondary to entrapment of other structures, and the procedure was terminated. What modifier should be used?
Split billing can be used with what modifier?
A patient was sent to the hospital radiology department for posteroanterior and lateral chest X ray after getting into a fight at school. The physician performed the procedure and dictated an interpretation and report. What is the modifier for the physician service?
Injection procedure for pyelography was performed by a surgeon through a pyelostomy tube. The surgeon used a Bier block as the anesthesia and performed the anesthesia services himself.
When a radiologist reads and interprets X rays performed in the hospital and the radiologist is not employed by the hospital (contracted), which modifier is used for each procedure the radiologist reports?
If a patient requests a second opinion, modifier 32 may be used.
This modifier is not to be used when laboratory tests are rerun to confirm the initial results.
