Wednesday, March 25, 2015

Coding Guidelines: Modifiers basic

Modifiers indicate a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.

When selecting the appropriate modifier to be reported with your claim, please ensure that the modifier is valid for the date of service being submitted.

Examples of when modifiers may be used are:
•    Identification of only a professional or technical component
•    Repeat services by the same or different provider
•    An increased, reduced or unusual service
•    Billing for components of a global surgical package
•    Identification of a specific body area
•    To designate a bilateral procedure
•    Identification of service in a clinical trial

Coding Guidelines: Modifiers - Complete Listing

  • Anesthesia Modifiers
  • Global Surgery Modifiers
  • Surgical Modifiers
  • Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Modifiers
  • Provider Quality Reporting Initiative (PQRI) Modifiers
  • Ambulance Modifiers
  • Other CPT Modifiers
  • Additional HCPCS Modifiers

Anesthesia Modifiers

One of the following modifiers must be reported with anesthesia services in the first modifier field to indicate who performed the anesthesia service:

Modifier    Description
AA    Anesthesia services performed personally by anesthesiologist
AD    Medical supervision by a physician: more than four concurrent anesthesia procedures.
QK    Medically directed by a physician: two, three, or four concurrent procedures
QY    Anesthesiologist medically directs one CRNA
QX    CRNA service: with medical direction by a physician
QZ    CRNA service: without medical direction by a physician

The following modifiers can be reported in the 2nd position under appropriate circumstances in addition to one of the previous anesthesia modifiers:

Modifier    Description
QS    Monitored anesthesia care service
23    Unusual anesthesia
Note: When using modifier 23, appropriate documentation must be submitted with the claim.

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