‘Symbols ‘Anesthesia Physical Status Modifiers ‘A Ravised code. Pt A normal healthy patient © New cote 2 Agatti tee dase A New or revised text PA patient with severe systemic disease ie Reloere to OTAstnt Cal Exapls Baran seer spac Ouse ats acon eet and CPT Changes [rent PS ‘Arnaribund patent wha is nt expected to survive without he operation + haoncode cee dnd pater wise tgs bey renee rr 8 Geng uous poset Fre pring FDA apa tn it A Pivcedectiond phere, Motifiers Approved for Hospital Outpatient Use 4 Teenie Level (CPT) i : 25 Sip, Sepnt Kent Eatin red Seniee Motifiers (See Asgondix for defitins) Sion apr Me ei ee Perle 22. sexed etal Sevens Bye dala ede rer Sect Zi Unsere 21 tipl Dtpten spa EM Erzzrtes nh Sane Ute Fh Unened kn an Maogenet Srey he Same So Prva Sevees Pyle er Gate Vath Cae Prete Dag 50 Bina Posen a. Stor ep ei tin a Fe ea ae. eee aon ot 8 ‘Staged ot Rated Procedure or Service bythe Same Physician or Other oven cervcy ta Sana Pca hee Se tae descr Dy be Pesto eos Soeceeiecieew | | 2 Semaine pa een ee ee 52 arian! Oupaen Pcie Mero Aste Aiton Ses 7, Dist nate! Pact Ae ArsheseMkisaton sag Meas Sa 7h Pusat Ped er Serie by Sona scan Orie Heath AT Anasthesia by Surgeon Corartesdonal ca 1 eoes Pech rte Pin ores Heath Ce ‘51, Multiple Procedures: fe M mM 10 Upland etn ie oe uemby Sone eres Ua ied ca Peer lo el $5 Disord Precoee fr rofl Pci Drg ha Fstop Patol 34 Sipe Cr Oo 7 Use Pena Sven Sra yn bw Oe! SS Poser Mangement Oi et sso Daeg te astepere Ped Pageant a1 Peoet inal oes abrityTet 57 Dre 3B Rog Raed ocedueo Sevics by he Sana Level I {HCPCS/National) Fats cine aed Heath Coe Peso! Dion I Lats ied oie pcos pred ne sid of thevesupeste Pet theo 9 Din cea Savin tahoe witty posts promed ont ht of 62 Two Surgeons ‘thebody) {63 Procedure Performed on ifort less than 4k EL Upper eh, eyelid | Supe Tom Lave oe | Frere rev by Sane Prin Or Bs per ihwt Bit ean aa resol Ee Lowered 1 enteadon by herp Oe Od FA Latah 2 nt Optra on Ft ae ” a0 om : Ulett el Fa akin ida Sa a cone aes Peete Osa ee f os i ihe ) erro ot Sesh Sane Meno 73 oe Ga tn Dora Fe thon redo | Postoperative Prod FD Fight and hire gt | so ssiton Sogeen Fe fit ad ort dt \| St Min Asst Sen i 8 Ra hse eal een an Peforan srg mgr nt dat 182 Asitant Surgeon when gai rs ne ene V ere anaes coeatiensceoyanmoyan an B Fayence abot Test te (aterm ay iui tra Pat ee 1b (atone cosy 6 22 Aer Teonenn Seren dt ene atin Scene a oan eM 1a La cpt ur aageerty a oi fat % OM eee ona amid Selby oro eerie AC fotoenratey ams creed toon ey Th loti gettae Th Uaklnt nt Tr attr te TS utlst oat at 74 lato th dot Te hon pate Seer ers et n hee ml TB Right foot, fourth digit pated re Ja. fight ot th dotAppendix A—Miodifiers cer 2018 Appendix A Modifiers reno ave noc eqied fx reporting ofthe F/M services sth me dre Th crcunsnce my be reported BY “This lac incldeal ofthe modifies pple ro CPT See ee ee ‘2018 codes, ‘Note: This modifier is not used to report an E/M. rae [sels jrrell Seeete trees eee intel adin pan ey Semler eae pac an ta eet Te 7 i ig pie Fea there ae pe PEE ad Nee aimee its definition or code. Modifiers also enable health care OPT Changes: An insiders Vew2008, 2013 posse a Nee ley Sor Anton och 096 1 Pepa che ald Oy uae 22 need Paedurl orcEs Ace er le Teute y Be Ey ig esr ‘inside seed een phys and aval cre: Note Tis moe Seal ecb spbnded oan BM rs $27 Otarges An insiders View 2008, ‘32. Mandated Services: Secvices relaced 0 mandated Derr Aston Jon 08 A028, un 038,10, 09 134 ‘coniultation and/or related services (eg cied parry payer, : eee Uae Athi Oia ith ey uence & Caceeaian (esate etd Geaeeane ieee DerrAeitenrng 312 (poral anaucia Ta eles aye oly Slog soln 2s otk eae oe ae 26 Professional Component: Certain procedures combination of physician or other qual professional componene and a technical comps the physician or other qualified health exe profess component i reported separately, the service may be identified by adding modifier 26 o the usual proced umber. Derchonge A ners Vw 2013 ED CPT Astana, 024, 8 027 5B Preventive Services: When the primary purpose ofthe serie isthe delivery ofan evidence asd servic: in accordance with US Peventve Services Task Fore Aor B ‘ating efect and other peveve eves idee in reventvesevies mandates (legiatve o ‘Same Physician or Other Qualified Health Core es = Professional Duting a Postoperative Periods The Por emer eas Pan relied eth opi may ee eee ee ee ‘need ro indicate that an evaluation and management service space ircararcen resin wis performed during a postoperative period fora cesson(s) ee “cated th gal procedure Ths creumstance may a Meanie iia pe nesthesia by Surgeon Regional or oneal anexhesia beta by ig bier 24 wth sproiteee ated SE oma ae of EDM serie moe 47 tothe basi service (This dacs no nlude DOT Derek ners Vi 013 Joc anesthesia) Now: Modier 47 would ot bese a ‘Significant, Separately Identifiable Evaluati pee ee pees ‘Manageme ty the Same Physician or Other ‘50 Bilateral Procedure: Unless otherwise identi ‘lied eal are roto! onthe Same Dayo fis ieopeeheatemsersiacr she Procedure of Other Sere, ie may be acenny vo senion shold be ened by adding moifier SO she inh on te oa post erie ei y Genres CPT code was perform, the patents coniion "cage ear at equi asian, separ enable IM sevice So eee above and beyond th other ervce provided or beyrd she J seul propre and pontperive cae ested with the procedure hat var pefonned. A significant sparty ideifiable EM service fined or woxanned by deocumenaion tha sis the wean ein re fored th tesformed atthe sme renon by the same individual the Ghee Bh sc paral ne tons Rarcetecsmcayh create Te | ices Galdelins for nseucion on intl procedure) or sevice) nny be denied y «determining level of E/M service). The B/M service may be appending modifier $1 co: ie z 1 Prompted by the symprom or condition for which pet usrapale ey ce ee 51 Multiple Procedure: When multiple procedure, other than B/M services, Physieal Medicine and Rehicion secvices or provision of supplies eg vaccine) ate vt > Shea mas ‘Ancona Fsolationcrr 2018 separate procedure codfs) with modifier 80 0¢ modifies added, 28 appropdin. {2 oF Cg An id's Vw 2013 153 Procedure Performed on infants less than 8 ka Procedures performed on neonates and infants up 0 & present body weight of 4g may involve signficanly Trereacd compleity and physician or other qualified treat eae professional woke commonly associated with there patents, This circumstance may be reported by reuing modifier 63 tothe procedure number, Note: Unless sthenste designated, this modifer may only be appended w procedursersces Tie inthe 20005-69950 code reset, Modifier 63 should not be appended to any CPT ‘ide tse inthe Ryaluation and Management Services, Ancnesia, Radiology; Pathology/Taboratory oF Medicine secon 007 One 80 8 Surgical Team: Under some cicurcancs, highly complex res (equiting the concomitant service of teeta jana or other qualified health care professionals often faiferene species, ps other highly skilled, specially trined personnel, various ype of complex equipment) are Carved oot under dhe “rurgical rx” concept. Such ramstances may be identified by each participating individual with the dition of modifier 66 ro the basic procedure number used for reporting eves, {rT Cer Aoi’ 2013 76 Repeat Procedure or Service by Same Physician or Other (ualified HealthCare Professional Ie nay be necesary co indicate that a procedure or service wa repeated bythe ‘ame physician o other qualified health exe professional bsequen othe orignal procedure or service. This Greursance may be reported by adding modifier 76 co the ‘epeated proceduteor service, Note: This modifier should pended to an BM service {07 gest ns Vi 08 20,2013 Derassicetrestes dure by Another Physician or Other etlth Care Protessional c may be necesary 10 indicate that basic procedure or service was epeated by nother physician o other qualified health care profesional tubsequent ode original procedure o service, This ‘reumstance maybe reported by adding modifier 77 tothe sepeaed pocedute or service. Note: This modifier should ‘nor be appended to an JM service DOr isp Anis ew 28, 20,2018 ‘Procedure Daring te Postoperative Paid ay be necry to indent hat another procedure was perfor disiog the ponopertve pro often presedue (anplnocd procure folowing inal produ, When ‘Mini ead eo tn pergola rom, i nay be repo by adn Silke raw tanuel peau Greer procedures, modifies 76) crt chee rie iw 20,2012 OLE DE (©=Nodier em Modifiers Appendix A the Same Physician Unrelated Procedure or Service by the y seiner Qualified Heath Care Professional During 1 Periods The individual may need indicate lial due o service duing the Tee performance of re egal pe prod was reeled 0h Oh ae Tr ceance may be sepored yg ee or epne procedures on hese Oa rear 76) armpit pasttan Surgeon Selatan services maybe ay lng fer 80 shel procedure nba) Hine Aatstant Surges Minin supine aon eed by dng oder Bo the oa peters sist Surgeon (hen qualified esidet surgeon ot iene - 82 appended co available: The unavailabiliy oF » surgeon isa prerequisite for use of mock he usual procedure code numbex Reference (Outside) Laboratory: When laboratory procedures are performed by 2 parry other than the eeating fr teporting physician or osher qualified health care profesional. the procedure may be identified by adding modifier 90 10 the usual procedure mumbes {©)07Fcbanger An nies View 2019 Repeat Clinical Diagnostic Laboratory Test In che course cof teatment ofthe pacien, ie may be necessary to repeat the same laboratory rex om the sae day ro obtain subsequene(mlciple) rex cenulis. Under these Circumstances, the laboratory est performed can be ‘denied by its wal proceduce number and the addition ‘of modifier 91, Note: This modifier may not be used when texte ae rerun co coafiem iil resus due ro testing problems with specimens or equiprent of foe any other feaion when a normal, onetime, cepestable sul i all hae Is tequlted. This modifier may not be wed when other code(s) describe a series of et results (g, glucose tolerance tents, evocative/suppresson texting). This modifier ay ‘only be used for laboratory cest(s) performed more than ‘once on the sume day on the same pint. DerrasstoeNay 028, Sst 327 ‘Atecatve Laboratory Platform Testing: When laboratory tering beng pefomed using ak or eanaporale Tazrument dha wally on pat cones of Single te dipole aan chambe, th service may be Weslied by alog modifies 92 the usual bortoey procure code (HI tenting 86701-86703, and 87389)-The test does toc ele peamanen data space hemes by ks den Myth ia vane enema pet cn ing i oh ton taadie {Der ore An her's a8 202 icslfdetcuminaive ofthe use of this ‘ncaa Medial Asoration” JAppendix A-—Modifiers 95 Synchronous Telemedicine Service Rendered Via a Real- Time Interactive Audio and Video Telecommunications System: Synchronous telemedicine service is defined as a real-time interaction bevween & physician or other qualified health cate professional and a patient who is located ata disrane site fom the physician or other qualified health eate professional. The torlity of the communication of information exchanged beoween the physician or other qualified health care profesional andthe patent during the couse ofthe synchronous telemedicine service must be of an amount and nature that would be suficient ro eet the key components andlor requtements ofthe sae service when rendered via face-to-face interaction, Modifier 95. may only be appended ro the services listed in Appendix P Appendix Piste list of CPT codes for services that ae ‘ypically performed face-o-fae, but may be rendered via a real-time (synchronous) inceraetive audio and video telecommunications system © ce omnes: snide’ View 27 > Habilitative Services: When a service or procedure that ‘may be either habilitative or rchabilitaive in nature is provided for halilitaive purposes, the physician or other ‘qualified health care professional may add modifier 96 ro she serves or procedure code o indiate thatthe sevice oF procedure provided was a habilitaive service, Habilitaive Services help an individual learn skills and Functioning for daily living cha che individual has not yet devsloped, and then keep and/or improve those laened sil, Habilative service also help an individual keep, learn, or improve kills and functioning for daily living © err oranges: An ier’ Vow 2018 flehabilitative Services: When a service or procedure that may be ccher habilitaive or tehabiliaive in manure i provided for rchabilative purposes, the physician or other ‘qualified health care professional may add modiie 97 ro the service or procedure code to indicate that che service oF procedure provided was a rehabilitative service. Rehabilitative services help an individual keep, get back, or improve skills nd functioning for daily living that have ben Jos or impaired because che individual was sick, hur, or disabled. © OF Change: ier Vow 7018 Mati Modiers: Une cen coma? cmos rds ay be neceary comply dine 4 tevin such situations ofr 9 sould be sed co the bse procedure ander apliabe modifies maybe Tied ay pur of he dessin the evi Anesthesia Physical Status Modifiers : Physical Status modifiers are consistent wi ch Pasay of anethcolgss anking of i é ite jeal satus, and distinguishing vasious levels aay a soasbese pried All yervices are reported by use ofthe anesthesia rr vopriae physical stacus modifier appended Example: 00100-P1 ‘Under certain circumstances, when another established modifier(s) is appropriate it should be used in addition to the physical status modifier. Example: 00100-?4-53 Physical Status Modifier P1: A normal healthy patient Physical Status Modifier P2: A patiene with mild systemic disease Physical Status Modifier P3: A patient with severe systemic disease Physical Status Modifier P4: A patiene with severe systemic disease chat is a constant threat to life Physical Status Modifier P5: A moribund patient who is not expected to survive without the operation Physical Status Modifier P6: A declared brain-dead patient whose organs are being removed for donor Purposes Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use CPT Level ! Modifiers Temay be necessary to indicate that on the day a procedure or service identified by 8 CPT code was performed, the patients condition required a significant, separately identifiable BM service above and beyond the other service provided or beyond the usual preoperative and postoperative cae associated withthe procedure thar was performed. A significa, separately identifiable EIM service is defined or substaniated by documentation that satisfies the relevant ctcria for the respective EIM service tobe reported (ee Evaluation and ‘Management Services Guidelines for instructions on setecmining level of E/M seevic)."The E/M service may be ‘prompced by the symptom or condition for which the procedure and/or service was provided. As such, different Aiagnoses are not required for reporting ofthe E/M services fon the same date This circumstance may be reported by adalng modifier 25 t the appropriae level of E/M secvice, "Note: This modifier is noc used to report an EIM service ‘that resulted in «decision to perfoom surgery. See modifier 537, For significant, separately identifiable non-E/M_ services, see modifier 59. 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