Medical Coding II – Supplemental
Seminar #7
Deborah A. Balentine M.Ed., RHIA, CCS-P
Kaplan University
CPT Modifiers
Modifiers are two digit numerical codes that are appended
to the CPT code for a service or procedure.
Modifiers are used to indicate that a procedure has been
altered by some circumstance but the description of the
code has not changed.
Modifiers are only used with CPT codes and should not be
appended to ICD-9-CM codes.
Using Modifiers
To report complications of surgery.
 To report mandated services.
 To report bilateral services.
 To report multiple procedures.
 To report reduced services.
 To report assistants/co-surgical services.
 To report cancelled or discontinued services
 To report unrelated services done during the global
period of another service or procedure.

Modifier 26
Modifier 26 is used to report the professional component
of a service or procedure.
The professional component is the clinician’s skill, effort
and/interpretation during a service or procedure.
Modifier 26 is generally used when reporting ancillary
services.
Modifier 26 is not used when reporting surgical services
because it is implied that the service is being performed
by a surgeon.
Modifier Pairs
Modifiers 24 vs. 25
Modifier 24 – Unrelated E/M service done during the global
period of another procedure or service.
Modifier 25 – Separately identifiable E/M service done with
another procedure or service
Modifier 24 vs. 25
2/1/10 – Patient has a total hip replacement by Dr. Miller
(27130 – 90 day global surgical period)
2/14/10 – Patient returns to see Dr. Miller in her office.
Patient had fallen off the bed at home and their wrist is
swollen. Dr. Miller examines the patient and
documentation supports a 99212 level of service.
What would you bill for DOS 2/14/10?
99212-24
Modifier 24 vs. 25
A patient comes into the office for a visit related to their
hypertension. Documentation in the medical record
supports a 99213 level of service. During the same
encounter, the physician removes a skin tag (11200) from
the patient’s forearm.
What codes would be reported for this encounter?
99213-25 (HTN evaluation)
11200 (Skin Tag removal)
Modifier Pairs
Modifiers 52 vs. 53
Modifier 52 – Reduced Services, used when only a portion
of a service or procedure is performed.
Modifier 53 – Discontinued procedure, used when a
procedure is cancelled before any definitive treatment is
given.
Modifier 52 vs. 53
A patient is admitted for repair of an incarcerated umbilical
hernia (49587), the patient develops an arrhythmia after
the anesthesia is administered and the procedure is
discontinued for the safety of the patient.
How would this encounter be reported?
49587-53
Modifiers 52 vs. 53
A patient has a malignant neoplasm and is scheduled for a
bowel resection (44120). During the procedure the
exploration determines that the tumor is inoperable and
the bowel resection is not performed.
What codes would be reported for this encounter?
44120-52
Modifier Pairs
Modifiers 73 vs. 74
Modifier 73 – Procedure cancelled prior to the
administration of anesthesia
Modifier 74 – Procedure cancelled after the administration
of anesthesia
Modifiers 73 and 74 are only used for hospital outpatient
facility services.
Modifier Pairs
Modifiers 62 vs. 66
Modifier 62 – Co-Surgery, used when two surgeons
perform distinct parts of the same surgery.
Modifier 66 – Team Surgery, used when two or more
surgeons perform different surgical procedures on the
same patient during the same operative session.
For Co-Surgery each surgeon must dictate a report
describing their role in the procedure
For Team Surgery, only the primary surgeon dictates the
Operative Report
Modifiers 62 vs. 66
A patient undergoes a below the knee amputation of the
left leg (27598). The primary surgeon for the case is Dr.
Gray, a general surgeon. Dr. Jones, a vascular surgeon also
participates in the case to cauterize the blood vessels
after the amputation and Dr. Bishop, a plastic surgeon
participates in the case to fashion the amputation stump.
How would this procedure be performed?
27598-66 reported by the primary surgeon only
Modifiers 62 vs. 66
A neurosurgeon and a ENT surgeon perform a
transphenoidal hypophysectomy (61548) for removal of a
pituitary tumor. The ENT surgeon performs the surgical
approach needed to gain access to the tumor and the
neurosurgeon removes the tumor. Each surgeon dictates
their own report with specifics to their portion of the
procedure.
How would the services for each surgeon be reported?
61548-62 for each surgeon
Modifier Pairs
Modifiers 76 vs. 77
Modifier 76 – Repeat procedure done by the same clinician
on the same day.
Modifier 77 – Repeat procedure done by a different
clinician on the same day.
Modifiers 76 vs. 77
Patient presents with a painful right forearm. Dr. Smith
orders and x-ray which is interpreted by Dr. Jones. The xray reveals a comminuted fracture (73090-26). Dr. Smith
reduces the fracture and sends the patient back to x-ray
to confirm the alignment. The x-ray is repeated and
interpreted by Dr. Jones
How would the services for Dr. Jones be reported?
73090-26 (1st x-ray)
73090-26,76 (2nd x-ray)
Modifier Pairs
Modifiers 78 vs. 79
Modifier 78 – Return to surgery for a complication arising
during the global period of a procedure.
Modifier 79 – Unrelated surgical procedure done during the
global period of another surgical procedure
Modifier 78 vs. 79
A patient has a partial colectomy (44190). The procedure
has a 90 day global surgical period. Three days later the
patient returns with wound dehiscence. The patient is
sent back to surgery for a secondary suture of the
abdominal wall (49900)
How would you report the return visit?
49900-78
Modifier 78 vs. 79
A patient is seen by Dr. Grace for a lesion removal of the
face (11641). The procedure has a 10 day global surgical
procedure.
The patient returns 6 days later with a laceration of the
forearm (12032) related to a fall which is repaired by Dr.
Grace by suture.
How would the second procedure be reported?
12032-79
Modifier Pairs
Modifiers 51 vs. 59
Modifier 51 – Multiple procedures, used to denote the fact
that different procedures were done during the same
episode of care.
Modifier 59 – Distinct Procedural Service, used to indicate
that a service or procedure was distinct or independent
from other services performed on the same day.
Modifiers 51 vs. 59
A patient presents for the excision of a 1.7 cm benign
lesion of the foot (11422) and a 2.0 cm benign lesion of
the ear (11442).
How would this encounter be reported?
11442 and 11422-51
Modifiers 51 vs. 59
A patient presents for the excision of a 1.7 cm benign
lesion of the foot (11422) and a 2.0 cm benign lesion of
the hand (11422).
How would this encounter be reported?
11422 and 11422-59
Modifier Pairs
Modifier 50 vs. LT and RT
Modifier 50 – Bilateral procedure, used to denote
procedures done on both sides of the body or on paired
organs during the same surgical encounter.
Modifiers LT and RT – Used to denote unilateral
services done on paired organs or structures.
Paired organs include the following:
Eyes
Kidneys
Extremities
Ears
Lungs
*Hernia Repairs
Nostrils
Breasts
Modifier 50 vs. LT, RT
A total knee arthroplasty is reported with CPT code
27447.
A patient presents for a total knee arthroplasty of the left
knee. How would this encounter be reported?
27447-LT
A patient presents for a total arthroplasty of both knees.
How would this encounter be reported?
27447-50
Modifier Pairs
Modifier 57 vs. 58
Modifier 57 – Decision for Surgery, used with E/M codes
to denote that the evaluation resulted in a decision to
perform a surgical procedure.
Modifier 58 – Staged or related procedure or service by
the same physician during the postoperative period.
Modifiers 57 vs. 58
A patient presents for the treatment of a humeral shaft
fracture with insertion of an intramedullary implant
(24516). The fracture is reduced but the surgeon
determines that it is too unstable for the implant at this
point. The patient returns one week later for the implant
placement (24999).
How would the placement be reported?
24999-58
Modifier 57 vs. 58
A patient presents for evaluation of a blue nevus on their
neck. Documentation supports a 99213 level of service.
During the encounter, the clinician determines that the
nevus needs to be removed. Informed consent is given to
the patient and the patient will return next week to have
the nevus removed.
How would this encounter be reported?
99213-57
Looking Ahead
Next Regular Seminar – Sunday, February 26th 7:00 – 8:00
pm
Topic – Endocrine, Nervous, Ocular and Auditory Systems
Study Smart!