I write this article again as a suggestion of many of my readers on my blog. This article is complete so that the scenarios have been cited for having a broader view of the proper use of some of these important parameters.
In this article I will describe the medical claims Modifiers - Modifier -25, -24, -51, -57, -59, -26.
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Modifier -25, 25: significant, separately identifiable evaluation and management service by the doctor on the sameDay of the procedure or other service:
This modifier must be added with an E / M service. This is the modifier, you must use the evaluation and management of the service the same day with others of the same medical procedure done that. He also met the usual pre-and post-operative with the procedure. In fact, with this modifier does not refer to a different diagnosis. The most important thing is that if the E / M levelto fulfill its essential components or if it is turned on in time with the patient (consultation and coordination) is based. You should use this modifier with caution. Must be medically necessary. As you know, there are procedures that all other maintenance and management.
We try to describe this modifier 25:
A patient came in their monthly follow-up for their chronic back pain. At the same time the patient complained of severe headaches. The pain physician performed a bilateral occipitalLock the patient at time of service. They added 25 for the modifier E / M code to indicate that both services have been made on the same day.
Do not use modifier 25 with E / M encounter led to the decision for surgery (we have a different modifier for this!)
Modifier -24, 24: independent evaluation and management service by the same physician during the postoperative period.
Show as a modifier, this is another modifier that you can attachwith an E / M-counter. It shows that the E / M encounter is not used during the global time.
We try to describe this modifier 24:
A pain specialist performed nerve damage aspect of the patient. During the normal post-operative global, the patient came into office with knee pain due to a severe fall on the ice, as evidenced by the patient's subjective information. The pain specialist will then report that E / M encounter with the patient by adding modifier 24 to showThis meeting is not in the postoperative period, the global context.
This modifier, modifier 25 has no such limitation with the level of E / M code, just that it is medically necessary, or time-based components are all satisfied.
Modifier -57, 57: Decision for Surgery:
A valuation and management led by the first decision of a surgical procedure in the E / M encounter run.
We try to describe these parameters:
An OB / GYN sees a patient who complainswith severe abdominal pain. It was discovered (by ultrasound, radiology and other diagnostic tests and documentation), the patient with an ectopic pregrancy is. Gynecology / obstetrics, laparoscopic surgery results on the same day. The E / M meeting will then be reported with modifier 57, which led to the decision for surgery. Laparoscopic surgery should be reported as performed on the same day without a modifier.
Modifier -50, 50: bilateralProcedure
You modifier 50 for procedures that are billable as bilateral course (or two sides, both sides) is performed on the same day, the same operative session, using identical anatomical organs (arms, legs, back) are attached.
A Facet nerve block is unilateral (bilateral may be provided as a bill). If you use a modifier 50, so that the account that only one unit on the application form as it is only a procedure is performed bilaterally. Although policies may vary from other taxpayers.You can ask for twice the list (Line 1 and Line 2 on the application form). You have the responsibility to clarify this with your insurers.
Even with this add-on codes with a modifier! Use this modifier to describe all procedures that have already executed through bilateral procedures.
Modifier -51, 51: the methods
This modifier is used in reporting the number of procedures performed by the same doctor the same day. Do not use this modifier "add-on" codes(See Appendix D of the CPT code book). Do not use this modifier for codes with "modifier -51 exempt" icon (see Annex E of the CPT code book). Do not use this modifier to an E / M code. This modifier can be by the same doctor the same day that the procedure be performed.
Coding Tip: The list of the highest permissible code (after the main procedure code) on the basis of the royalties.
Modifier -59, 59: distinct procedural service
Description of the modifier-59: In some cases, the physician must indicate that a procedure or a different service or has been taken independently of other services on the same day.
Modifier 59 is for procedures / services, to identify not normally reported together but are appropriate in the circumstances. This can cause a different session or patient, different procedures or surgery, different site or organ system, separate incision / excision, separate lesion or separateNo injury (or area of injury for large lesions) normally encountered or performed on the same day by the doctor. However, when another already established modifier is appropriate, should be used instead of modifier 59 only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.
With this modifier only if the other is a separately identifiable procedure code. Procedure, thedifferent and can be described as an independent process, which met the separate anatomic site, lesion, lesion site, several organ systems and others. Do not use this modifier for E / M code.
Modifier -26, 26: the professional component
This modifier is used only for the professional component (physician) for a service or procedure. Some procedures are a combination of professional and technical components. Through the use of modifier 26, this means that the proceduresreported as the professional component.
Professional component for the technical component. For illustration, the procedures performed in a hospital or outpatient facility as the ASC, these plants are owned facility. The plant will then report the technical component for such activity, while the number of medical professional for which this process is to be reported. A good example, the block paravertebral facet physician under fluoroscopic control with CPT codeThe medical report 77003 with modifier 26 with fluoride for his / her professional component. During installation, the same procedure with modifier-TC for the technical component is reported.
Modifier LT or RT-be used to point to a site on the left or right or anatomical. So, if the cervical facet pain specialist performed on the left block, add modifier-LT to be used in this report procedure.The modifiers to describe your needs in the service sectorperformed on a patient for a reasonable compensation. Always consult your career taxpayers and local third-party for local determination, the principles and guidelines for these modifiers. Looking at the changes is very important!
Understanding Medical Claim modifiers - The modifier -25, -24, -51, -57, -59, -26