I am writing this article again as a suggestion from many of my readers on my blog. This article is more comprehensive, so the scripts were named to have a larger look at the proper use of some of these important modifiers.
In this article I will describe the modifiers of medical claims - modifiers -25, -24, -51, -57, -59, -26.
Modifier -25, 25: A significant, separately identifiable assessment and management service by the same doctor on the same day of the procedure or other service:
This modifier must be added using the E / M service. This is the modifier that you will need to use with the evaluation and management service performed on the same day, with a different procedure performed by the same doctor. This should be higher and higher than the usual preoperative and postoperative meeting with the procedure. In fact, using this modifier, it should not have another diagnosis. Most importantly, the E / M level should correspond to its key components or if it is selected based on time with the patient (counseling and coordination). You must be careful when using this modifier. It must comply with medical necessity. As you know, there are procedures that already include all other types of care and management.
Let this modifier be 25:
The patient came to her monthly observation of her chronic back pain. At the same time, the patient complained of some headache. A sick doctor performed a bilateral occipital block on the patient during service. You will add a modifier of 25 for the E / M code to indicate that both services were displayed on the same day.
You are not using a modifier 25 with an E / M meeting caused by a surgery solution (we have another modifier for this!)
Modifier 24, 24: Unrelated service assessment and management of the same doctor in the postoperative period.
As the modifier indicates, this is another modifier that can only be added using the E / M counter. This indicates that the E / M meeting is not connected in the global period.
We describe this modifier 24:
The hospital specialist performed the destruction of the facet nerve for the patient. During the normal, postoperative global period, the patient came to the office with severe knee pain due to falling onto the ice, as evidenced by the patient’s subjective information. A hospital specialist reports that E / M is facing the patient by adding modifier 24 to indicate that the meeting is not related during the global postoperative period.
This modifier, such as modifier 25, has no limitations, as with the level of the E / M code, if it corresponds to medical necessity, to all its components, or based on time.
Modifier -57, 57: Surgery Solution:
The evaluation and management service provided in the initial decision to conduct the operation during the E / M meeting.
Describe this modifier:
OB / GYN sees a patient who complains of severe abdominal pain. It turned out (through ultrasound, radiology and all other diagnostic tests and documentation), the patient has ectopic adherence. OB / GYN performs laparoscopic surgery on the same day. The E / M meeting will be reported with modifier 57, which is sent to the decision for the operation. Laparoscopic surgery should also be reported as performed on the same day without a modifier.
Modifier -50, 50: Bilateral procedure
You will add a modifier 50 for procedures that are obviously paid as bilateral (or two sides, both sides), performed on the same day, on the same live session, on identical anatomical sites, org (arms, legs, spine).
The facet nerve block is one-sided (can be specified as bilateral). When using the modifier 50, make sure that you only invoice one unit in the application form, since only one procedure is performed bilaterally. Although the recommendations of other taxpayers may differ. They may require you to list it twice (line 1 and line 2 in the application form). You should be responsible for clarifying this with your payers.
You also use this modifier with additional codes! Do not use this modifier with procedures that are already described as two-way procedures.
Modifier -51, 51: Several procedures
This modifier is used when multiple procedures are being performed by the same doctor on the same day. Do not use this modifier for add-on codes (see Appendix D for the CPT codebook). Do not use this modifier for codes with the symbol “freed from the modifier -51” (see Appendix E of the book of the CPT Code). Do not use this modifier with the E / M code. This modifier can only be used by one doctor on the same day that the procedure was performed.
Coding Board. List the highest refund code (after the main procedure code) based on a schedule of fees.
Modifier -59, 59: Clear procedural service
Modifier Description -59: Under certain circumstances, the doctor may need to indicate that the procedure or service was different or independent from other services performed on the same day.
Modifier 59 is used to define procedures / services that are not normally reported together, but are appropriate in the circumstances. This may be different sessions or patient sessions, different procedures or operations, different site or organ systems, a separate incision / removal, a separate lesion, or a separate injury (or an area of injury with intensive injuries) that are not usually found or performed on same day by the same doctor. However, when another already installed modifier is appropriate, it should be used, and not modifier 59. Only if there is no more descriptive modifier, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.
Use this modifier only if the other procedure is a separately identifiable procedure code. A procedure that is different and can be described as an independent procedure, on a separate anatomical site, lesion, injury site, in different organ systems and in different sessions. Do not use this modifier for E / M code.
Modifier -26, 26: Professional component
This modifier is used only for the professional component (doctor) of the service or procedure. Some procedures are a combination of both professional and technical components. Using modifier 26, he indicates that the procedure is only reported as a professional component.
Professional component compared to the technical component. In the illustration, the procedures provided at the facility, such as an outpatient hospital or ASC, this equipment belongs to the facility. The facility will then report the technical component for this service, while the doctor informs the professional component. One very good example is working with the doctor's paravertebral facet under fluoroscopic guidance using the CPT code 77003. The doctor will report fluoride with modifier 26 for its professional component. The object will report the same procedure with the -TC modifier for the technical component.
Modifier -LT or -RT used to refer to the left or right side or anatomical site. Therefore, if the pain specialist has completed the left cervical block, you will add the -LT modifier to report this procedure. The above modifiers are used to describe your applications for services performed by the patient for the appropriate payment. Always consult your local career and third-party payers to determine the locations, policies, and recommendations for these modifiers. Looking for change is also very important!
