Table of Contents
Initial evaluation – minor procedure
E/M service same day
Initial evaluation – major procedure
Assistant at, co-surgery, team surgery
Using CPT and HCPCS code modifiers correctly is critical to ensure accurate and timely payment. Some modifiers bypass the claims editing system, allowing a practice to be paid for multiple services on the same day. This makes understanding and using modifiers correctly essential to protect revenue.
But, because they affect revenue, using modifiers is also a significant and serious compliance issue. Using modifiers only when it follows coding rules is essential. It will protect a group from overpayments and refund requests.
According to the CPT book
A modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed and its definition of the code.
That is, a modifier indicates that there were some special circumstances about the provision of the service.
There are two sets of modifiers. CPT modifier codes are found in the first appendix of the CPT book and are numeric modifiers. Most of these modifiers affect payment.
A second set of modifiers are found in the HCPCS book. These HCPCS modifiers are alphanumeric or alphabetical. Some of these modifiers are informational only and some are related to compliance. For example using the modifier RT provides the information that the service was performed on the right side.
This 18 page guide will address frequently used CPT and HCPCS code modifiers.
CodingIntel members can also listen to the companion webinar on demand.
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