CPT Modifiers in Billing and Coding

CONTENTS

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1-Introduction

2.1. Control blood pressure:

2.2. Maintenance of a healthy lifestyle:

2.3. Management of diabetes:

2.4. Regular exercise and limit overuse of medicine:

2.5. Regular check-ups screening and staying hydrated:

3-Conclusion

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1-INTRODUCTION

CPT modifier (Current Procedural Terminology) is a two digit code that is most

commonly used in medical billing and coding. CPT used for the information about procedure or

services in the medical billing that a healthcare provider offers to its patient. CPT two-digit code

explain specific procedure, variation or circumstances during the provided treatment. CPT

modifiers provide additional details or description of services or care link the physician services.

Modifier clearly describe medical procedure with making changes in its definition. Article will

shed light upon the commonly used CPT modifiers used in medical billing and their meaning.

2.1. CPT Modifier 25:

It is used for evolution and management of services or procedure that a same healthcare

provider offer to its patient on same day as new service or procedure offer to patient by another
professional on same day. It might be possible that patient receive services and procedures

mentioned in the code but needs evolution and management of procedure or services beyond the

identified services beyond usual post or preoperative patient care. The evolution and

management of services are prompted with the condition of patient. It also requires reimburment

of both procedure and evolution and management (E/M) of services.

2.2. CPT Modifier 50:

It is used to indicate performance of additional procedure on the both sides of body

during the same or encounter operative sessions. Modifier used for the symmetrical performance

of procedure on body parts like eye and knees.

2.3. CPT Modifier 51:

Modifier 51 is used for performing two or more procedure together in the same or

encounter session. It is indicate that payer needs to make additional reimbursement for new

procedure in medical billing.

2.4. CPT Modifier 58:

It is used pre-planned and documented therapy that a patient received after a major

surgery. The surgical modifier 58 in medical billing taken as new procedure requires

reimbursement for continuity of new medical procedure in post-operative period. It almost cover

all the procedure linked with first operation.

2.5. CPT Modifier 59:

Modifier 59 is used when two or more procedure has to be perform on a same patient at

the same day but not as bundle together. It used to indicate that there should be separate

reimbursement for additional procedures in medical billing.

2.6. CPT Modifier 76:

It is used for the repetition of medical procedure on the same day due to some certain

medical condition. It clearly indicate that services or medical procedure should be repeat on

same day subsequent to original medical procedure. Modifier 76 clearly shows the difference

between the repeated and duplicate services.

2.7. CPT modifier 78:

It is used for the unplanned post-operative procedures. It indicate the unplanned return of

a patient to Operation Theater or procedural room right after getting original treatment. It

indicate the unexpected outcome of previous surgery like infection, hemorrhage or debridement

after surgery requires immediate return of patient to operative or procedural room. The key is

second procedure must be link with the first medical procedure. In addition to it, surgical

modifier 78 is not only used to fix complications but also tackle everything that related to post-

operative procedure.

2.8. CPT modifier 79:

It is used for the return of patient to same healthcare professional during post-operative

period for receiving unrelated medical services. It requires to perform different procedures or

services on same anatomical site by the healthcare provider during the post-operative period.

3-CONCLUSION

Article has discussed few example of CPT modifiers. There are multiple CPT modifiers

are available to convey specific information related to the service period. The thing that needs to

understand is to consult official guideline of CPT coding. So that payer will able to pay for the

specific services used for coding and medical billing purposes.