You see them all the time and we’ve talked briefly about CPT codes before so you probably have a general idea as to what they are and how to use them. But what are modifiers? Here are some quick facts about CPT code modifiers that may help.
What are CPT code modifiers?
CPT Code modifiers are 2 digit codes that add onto a CPT code. They are added at the end of a CPT code with a dash and can be numbers or sometimes can include letters as well.
What is the purpose of CPT code modifiers?
Modifiers are used to add more information onto the procedural codes in order to give more details about what, how, why, where etc. the service was performed when the procedures are complex. They work to provide extra information about the procedures that insurance payors need to know.
What can this look like?
For example, 00216-P1.
The 00216 is the CPT code while the P1 is the modifier. As we’ve seen before, each CPT code describes a procedure that was performed. The modifier provides additional information to that procedural code. 00216 in this case is an anesthesia code for procedures of the head. The P1 modifier defines a “normal healthy patient”. This would be used to code for an otherwise healthy patient who underwent this particular procedure.
What are some other modifier examples?
Anatomic Modifiers – E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI
E1 for example is used to describe procedures performed on the upper, left eyelid. LT or RT is used to describe if the procedure was done on the left side and right side of the body.
Global Surgery Modifiers – 24, 25, 57, 58, 78, 79
For example, 24 is used to describe post-operative visits or services that are unrelated to the diagnosis for why the surgery was performed, unless it is related to a complication of the surgery.
Other Modifiers – 27, 59, 91, XE, XS, XP, XU
Modifier 91, for example, used when there have been repeat lab tests or studies performed on the same patient on the same day.
What happens when modifiers are incorrect?
If this happens, then claim payments could be delayed or denied. If you correctly code the first time, then your claims can get paid quicker. If there are any delays or denials, then more work needs to go into correcting these mistakes which can affect your revenue cycle.
Where can I find more information on CPT codes and modifiers?
You can learn more about CPT modifiers through the Centers for Medicare & Medicaid Services’ document on its general correct coding policies, updated for 2021. It is important to review these and know exactly when to use which modifier in order to submit claims correctly and effectively the first time.
You can also contact Americare Network and learn more about how we can help your healthcare practice with your medical coding and billing needs.
