Name the appropriate modifier CPT/HCPCS 1. When identical procedures are perform
ID: 212635 • Letter: N
Question
Name the appropriate modifier CPT/HCPCS
1. When identical procedures are performed on both members of a set of paired organs, such as the lungs 2. Planned sigmoidoscopy for removal of a foreign body not completed due to the onset of atrial fibrillation. 3. When a separately identifiable E/M service is performed by the same physician on the same day of a procedure. What is the modifier that would be assigned to the E/M code 4. When a consultation is performed as a required second opinion 5. When a patient is seen in two hospital outpatient department on the same day, what modifier should be applied to the second E/M code? 6. When ambulance services are provided under arrangement by a provider of services, what modifier is applied to the ambulance service 7. Reposition of the right ulna bone 8. Amputation of the left great toe 9. Removal of a cyst for the left upper eyeid 10. Therapeutic interventional procedures on the ramus intermedius coronary arteryExplanation / Answer
1.CPT Modifier 50.
Reason:Modifier -50 is used to report bilateral procedures performed during the same operative session. Modifier -50 is used only if the same procedure is performed on both paired body parts.
2. Modifier 53
Reason:
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. This circumstance may be reported by adding Modifier -53 to the code for the discontinued procedure.
3.Modifier 27
Reason: The CPT defines modifier 27 as "multiple outpatient hospital evaluation and management encounters on the same date." Use this modifier when a patient receives multiple E/M services performed by the same or different physicians in multiple outpatient hospital settings
Modifier 27 should be appended only to E/M service codes within the range of 92002-92014, 99201-99499 and with HCPCS codes G0101 and G0175.
4. Modifier 32
Reason:
Modifier 32 Mandated services applies when a third party, such as an insurer or government agency, specifically requests/requires a service on a patient’s behalf.
Eg. An insurer seeks a “second opinion” on a patient’s condition, prior to authorizing further testing and/or treatment
5. Modifier 25.
Reason: Modifier pertains to Significant, Separately Identifiable E/M Service by Same Physician on Same Day of Procedure or Other Service.modifier -25 is used to designate a significant, separately identifiableE/M service provided by the same physician/qualified NPP to the same patient on the same day as another procedure or other service with a global fee period.
6.Level II modifier QM
Reason: Ambulance service provided under arrangement by a provider of services
7.
8. Modifier 79
Reason: Modifier 79 – Unrelated procedure by the same physician during the postoperative period
The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance must be reported by using the CPT modifier 79.
9.Level II modifiers E1
Reason: E1 Upper left, eyelid
10.Modifier 59: LC or LD
Reason: Modifier 59 Distinct Procedural Service
Definition: The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. This may represent a different session or patient encounter, different procedure or surgery, different site, or organ system, separate incision/excision, or separate injury .
LC -Left circumflex coronary artery
LD -Left anterior descending coronary artery
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