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April 6, 2017

The ABCs of CPT Modifiers

April 6, 2017

cpt modifiers

Because of the complexity of medical procedures and services, additional information is often necessary when coding. This information typically comes in the form of what’s called a CPT modifier, which describes how many procedures were performed, why they were necessary, where they were performed on the body, how many surgeons were involved in the operation, and more.

Below, we’ll go over the basics of CPT modifiers and how to use them correctly.

How Are CPT Modifiers Constructed?

CPT modifiers are always made up of two characters, either numeric or alphanumeric. Most are numeric, but some anesthesia modifiers are alphanumeric.

These modifiers are attached to the end of a CPT code without a hyphen. If you have more than one modifier, you’ll code the “functional” one first, followed by the “informational” one. How can you tell the difference? It’s easy – list the modifier that affects the reimbursement process the most directly first.

Why Does Order Matter?

The reason we list modifiers in a certain order is that payers don’t always consider modifiers after the first two. (CMS-1500 and UB-04 provide space for four modifiers, though.) Because of this, the first two modifiers are the most important ones, and you want to make sure they are visible.

What’s an Example of a CPT Modifier in Anesthesia?

Anesthesia has its own special set of modifiers that correspond to the patient’s condition as anesthesia is administered. The following is a list of these codes:

  •      P1 – a normal, healthy patient
  •      P2 – a patient with mild systemic disease
  •      P3 – a patient with severe systemic disease
  •      P4 – a patient with severe systemic life-threatening disease
  •      P5 – a moribund patient who is not expected to survive without the operation
  •      P6 – a declared brain-dead patient whose organs are being removed for donor purposes

These codes are pretty straightforward, but let’s consider an example of how they might be used. If a patient needs to be anesthetized before undergoing a procedure, then you would turn to the appropriate section of the CPT codebook and find the correct code that you need. If your patient is otherwise in good health, you would add the P1 modifier to your code.

Need Help with Your Coding and Billing? Contact MBM Today!

If you’re ready to let Medical Business Management worry about your practice’s coding and billing so that you can focus on your patients, contact us to start a conversation about our services. We are ready to remove that burden from your shoulders – and there’s no one better able to handle it than us!

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