CPT - Modifier and Uses

Modifiers are used to provide additional information to the insurance company, also for detail information to the clinic/hospital/Doctor/patient/ etc.,. to make sure that claims are get paid for services rendered by the physicians in a timely manner. The name modifier itself explaining that it is modifying the CPT. AMA & HCFA introduced and copyrighted by AMA.

Bilateral Procedure

E/M procedure done on the same day

Multiple procedures performed by physicians

Professional / Technical

Assistant Surgeon

Global Period

HOSPICE patient

E/M services resulted to decision of surgery etc.,

Modifier 22

Modifier 22 identifies a procedure that took more time than anticipated, or a procedure that was more complex or difficult than usual.

Modifier -25

 Separately identifiable evaluation and management service by the same
physician on the same day of the procedure or other service:

This modifier must be appended with an E/M service. This is the modifier you will need to use with
the E/M service done on the same day with other procedure done by the
same physician. It has to be above and beyond the usual preoperative and postoperative
encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different
diagnosis reported. The most important thing is that, the E/M level should meet its key components
or if it is selected based on time with the patient (counseling and coordination). You have to be careful in using this modifier. It must meet medical necessity.

Modifier 24

       Unrelated E/M services by the same physician during postoperative period

Modifier 26

     Professional Component  

Modifier 47

     Surgeon provides general or regional anesthesia to a patient, not use this modifier if the doctor administers local anesthesia.

Modifier 50

   Bilateral Procedure

Modifier 51

   Multiple Procedures

Modifier 53

   Modifier 53 for procedures terminated due to life-threatening circumstances.

Modifier 57

   E/M services resulted to perform Surgery

Modifier 59

   Distinct Procedure Services

Modifier 62

   When two physicians work together on the same procedure, we need to use 62 modifier allows both physicians to bill for the same procedure code.