Medical Billing and Coding Resources
Basics of Modifier 27 Modifier 27 is for hospital/outpatient facilities to use when multiple outpatient hospital evaluation and management (E/M) encounters occur for the same beneficiary on the same date of service. This modifier is exclusive for hospital outpatient departments, including hospital emergency departments, clinics, and critical care. Physician practices may not use this modifier. […]
Basics of Modifier 90 Reference (Outside) Laboratory: When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. Modifier 90 is used by a physician or clinic when the laboratory tests […]
Basics of Modifier 77 Repeat procedure or service by another physician. Modifier 77 is used to identify when the same procedure has been performed by a different provider to the same member on the same date of service or within the post-operative period of the original procedure. Documentation is required that explains the circumstances necessitating […]
Modifier 22: Increased ProceduralServices Increased Procedural Services is used when the work required to provide a service is substantially greater than typically required. Under certain circumstances, it may be necessary to indicate that a procedure or service is significantly greater than usually required. You may report modifier 22 when work to provide a service is […]
Modifier 79: Unrelated Procedure Unrelated procedure or service by the same physician during the postoperative period. Submit this modifier when an unrelated subsequent surgery is performed by the same surgeon within the global period of a major or minor surgery, regardless of whether the subsequent surgery required a return to the operating room. If a […]
Modifier 78: Unplanned Return to Operating Room Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period Modifier 78 is used to report an unplanned return to the operating or procedure room, by the same physician, following an initial procedure for a related procedure […]
59 Modifier: Distinct Procedural Service The CPT Manual defines modifier 59 as, Distinct Procedural 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 is used to identify procedures/services, other than E/M services, that are […]
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 modifier 57 to the appropriate level of E/M service. The submission of modifier 57 appended to a procedure code indicates that documentation is available in the patient’s records which will […]
Modifier 52: Reduced Services Modifier 52 is used to describe circumstances in which services provided were reduced in comparison to the full description of the service. CPT Appendix A for modifier 52 states, ‘Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s discretion. Under these circumstances the service provided […]
Basics of Modifier 58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period The modifier 58 is defined by CPT as ‘staged or related procedure or service by the same physician during the postoperative period.’ Further, according to CMS.gov, modifier 58 indicates that the procedure was: Planned, either at the […]
