The Basics of Modifiers Used in Coding

Medical Code Modifiers Explained

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Some CPT and HCPCS codes required the use of modifiers. They consist of a two digit number, two letters or alphanumeric characters. CPT and HCPCS code modifiers provide additional information about the service or procedure performed. Modifiers are sometimes used to identify the area of the body where a procedure was performed, multiple procedures in the same session, or indicate a procedure was started but discontinued.

Modifiers do not change the definition of the procedure codes they are added to.

Modifier Tips

  • For a complete list of modifiers, turn to Appendix A of the CPT manual
  • Append modifiers only according to individual insurance payer guidelines
  • Modifier use is different for physicians and hospital services
  • Not all modifiers can be used with all CPT and HCPCS codes
  • Refer to the National Correct Coding Initiative (NCCI) for accurate Medicare and Medicaid coding
  • Become familiar with modifiers that are overused or used incorrectly
  • Inappropriate coding of procedure code modifiers can cause a delay or reduction in payment

Commonly Used Modifiers

Modifier 21 (Prolonged) is used to identify E/M (Evaluation and Management) services when the service exceeds the highest level of care that can be reported.

Modifier 22 (Unusual Procedural Services) is used to report extra time and work for services when the services provided exceeds the description of the procedure being reported.

Modifier 24 (Unrelated) is used to identify E/M (Evaluation and Management) services provided on the same day of the surgery by the surgeon but is unrelated to the surgery.

Modifier 25 (Significant Separately Identifiable) is used to identify E/M (Evaluation and Management) services as separate from another service performed on the same day by the same provider.

Modifier 26 (Professional Component) is used to identify the professional component of a service performed by a physician or interpretation of the services performed by a physician.

Modifier 50 (Bilateral Procedures) is used to identify bilateral procedures during the same operative session.

Modifier 51 (Multiple Procedures) is used to identify multiple procedures performed on the same date, secondary procedures, or procedures performed during the same operative session by the same physician.

Modifier 53 (Discontinued Procedure) is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to the patient’s well-being.

Modifier 59 (Distinct Procedural Service) is used to identify services or procedures performed on the same day due to special circumstances that are not normally reported together.

Modifier 91 (Repeat Laboratory Procedure) is used to identify laboratory services or procedures performed more than once on the same day.

Modifier GA (Waiver of Liability Statement on File) is used when the services being performed are not considered medically necessary. Refer to Advanced Beneficiary Notice.

Modifier GX (Notice of Liability Issued) is appended to the appropriate procedure code(s) to indicate a voluntary ABN was provided for noncovered services for which the patient is responsible for (i.e. self-administrative drugs).

Modifier GY(Item or Service Excluded)  is appended to the procedure code(s) not listed on the ABN that are considered by Medicare as noncovered for which the patient is responsible for (i.e. self-administrative drugs). Modifier GY and GX may be reported together.

Modifier GZ (No ABN Obtained) is used when the item or service expected to be denied as not reasonable and necessary, but the provider didn't provide and Advance Beneficiary Notice (ABN).

Modifier TC (Technical Component) is used to identify the technical component of a service performed by a physician or interpretation of the services performed by a physician.

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