what is a modifier well a modifier is a two-digit code that gets added to the end of a cpt or a hitpix code if you're confused about modifiers don't worry because when i started out in the billing office before i became a certified coder i was slapping modifiers in all kinds of places that they didn't belong you can find most commonly used modifiers on the inner flap of your cpt book but there's actually full descriptions of them in appendix a of your cpt there are some modifiers though that you won't find in your cpt book so if you can't find them in cpt there's a good chance you're going to find them in your hicpix book the higpex book's going to have a lot more in-depth modifiers things like anatomical locations or things that are insurance specific that you may have to go to those insurance websites to find out how exactly they want you to utilize those modifiers today i'm going to help clarify just a little bit about what modifiers are used for and some of the commonly used ones and some resources that you can use to find more information [Music] hey everyone i'm victoria i'm a medical coder auditor educator and content creator and on my channel i provide tips tricks and tutorials to help you be successful in a medical coding career so a modifier is a two-digit code that gets added to a cpt or hectic's code never a icd code it goes on box d of your 1500 form right next to that cpt or hypix code and what it does is it adds a little bit of additional information or clarity regarding that cpt or hypix code without really changing the inherent description of that code so a modifier modifies that cpt or hypix code if you think of it kind of like photography you're taking a picture of something let's say it's a photo of the beach depending on the lens that you use you can have a different outcome but you're still taking a picture of the beach right so if you twist the lens one way that picture is going to go into focus and that's the right modifier if you're using the right lens at the right clarity that's the right modifier in that kind of scenario but if you're using the wrong lens you're going to get a blurrier picture right and that's kind of what a modifier is you're still taking the same picture you're still using the same camera but depending on those different little lens settings you may get a different picture right you can have a panorama versus something very focused let's say for example a surgeon is doing a hernia repair and when they go in and open up the patient maybe that patient has a large body habitus they had prior abdominal surgery so there's scar tissue they have to do a lysis of adhesions and that surgery that normally takes them two hours took them three hours because of those additional complications well we have a modifier for that modifier 22 so modifier 22 is increased procedural service and that's what happened the procedure was increased so again we're bringing that into a better focus this wasn't a normal hernia repair it was an increased hernia repair now sometimes because the procedure was more difficult and we're putting on the modifier 22 insurances are going to want to see documentation because some insurances will actually pay a slight increase of what they normally would have paid because of the extra added complication so most billing offices if they have a modifier 22 will have some sort of system in place that they will automatically send the documentation with that claim so some modifiers will explain that something was more complex or it was done on a certain part of the body or why something was not included in a normal global surgical package and some modifiers can impact payment another example is modifier 62 which is a co-surgery and for coding definition that means that two surgeons are doing the same procedure as defined by a cpt code and they're each going to get paid 62 and a half percent of the fee schedule for medicare so maybe one provider is doing the opening and closing another is actually removing part of an organ it's the same cpt code they each build the same cpt code with modifier 62 and they get paid 62.5 percent from medicare this can get confusing for providers and coders because the provider will often think that something is a co-surgery maybe they're doing a procedure on the wrist while someone else is doing a procedure on the leg but those are two different cpt codes so while they are working in tandem with another provider another surgeon it doesn't meet that coding definition of a co-surgery unless it's the same cpt code and we do see that sometimes in coding that clinical definitions don't always match up with coding definitions technically from a clinical aspect any piece of vascularized tissue is considered a flap but for coding purposes a flap is not always what a provider documents as a flap we also have modifiers that can indicate things around a surgical package so let's go back to our hernia repair that patient's going to have a 90-day global surgical package meaning those routine follow-up appointments that they're going to have with their provider to check their pain levels to check that they're healing well those are typically included in that payment for 90 days but sometimes other things happen within that 90 days and they might be related they might be not related to that initial surgery for example we have modifier 58 indicating that it was a staged or related procedure within that 90-day global so it was a planned thing i used to see this a lot in plastic surgery we would have patients that had breast cancer they would have a mastectomy and they would remove the breasts and then place a tissue expander to expand the tissue back so they could put in a permanent breast implant after they had stretched the tissue out to the appropriate size so after they had stretched the tissue out within that 90 days and they went back for that implant exchange that was a planned procedure we knew ahead of time that that was the plan that we were going to remove the breast put in the tissue expander and then replace it with a permanent implant so while they're in that 90-day period where typically things related to that original procedure are going to be included this was a planned procedure that we knew ahead of time that we were going to have to do at a certain interval for that patient a 78 modifier would indicate that we're in the global period but something happened that was related to this procedure but it wasn't planned so maybe the patient had a hematoma that needed to be evacuated the next day so we went in and evacuated that hematoma it was technically caused because of that original surgery it was related to that original surgery but we didn't plan that we were going to have to remove that hematoma 79 is when it is completely unrelated so say a patient goes in for their right carpal tunnel surgery and then we decide two months later we can do their left carpal tunnel surgery that's not related because this is the right side this is the left side totally unrelated or maybe the patient goes in for a rotator cuff and then two weeks later they broke their leg totally unrelated to that original surgery we also have modifiers for different anatomic locations so you'll find ones for each of your fingers each of your toes your upper eyelids lower eyelids and then right left and bilateral now when we talk about our rt for right and our lt for left and r50 for bilateral you have to consider things that you have almost a pair of so i have two hands i have a right hand i have a left hand i have a right eye i have a left eye i have a right leg i have a left leg i don't have a right and left trunk i have one trunk so even though something was maybe done on the right side of the trunk that doesn't always mean that we need to put an rt modifier on it because we only have one trunk same thing with things like neck you have a right side and left side of your neck but you only have one neck so the rt and lt are more for things that you have right and left of kidneys and so forth some of the encoder products that are out there like you guys know i love my codify with the aapc if you type in a cpt code it'll give you the modifiers that are allowed to be used with that cpt code they're not always 100 correct but if i type in for example 14301 which is an adjacent tissue transfer of any area you can see that the rt and lt is not on there because there's not a right and left any area and you don't have to use something like a 50 modifier for bilateral if the cpt description itself says bilateral in it and of course just because something meets a coding guideline doesn't always mean that the insurance is going to accept it so sometimes it might tell you in an encoder oh yeah you can put an rtlt on there but the insurance is gonna kick it out by the way if you haven't already i would highly encourage you to subscribe and hit that notification bell so you can get alerts when i post new episodes and if you need more information on modifiers and this is especially great if you already have an aapc certification if you go to my website contempocoding.com i have a free webinar on modifiers for the office so a lot of things that you'll talk about in the office like the 25 modifiers the reduced services and how to navigate different scenarios two of the biggest modifiers that we have problems with are 25 and 59 so 25 modifier only goes on an evaluation and management service and when i say evaluation to management i mean your evaluation and management section of cpt so it doesn't always mean office visit it doesn't mean inpatient visit it means what's in this section here of your evaluation and management in cpt so a 25 modifier can only go on an evaluation and management service when it is done this the same day as a significant and separately identifiable procedure so let's say a patient's coming in for their routine visit to check on their chronic conditions their diabetes their hyperlipidemia and while they're there the provider goes oh you know what there's something in your ear you have impacted cerumen we're going to have to remove that that's a significant separately identifiable procedure they came in for management of their chronic conditions they had a different procedure by different cpt codes on the same day or maybe they came in for their chronic condition management and needed some sort of injection or a mole that looked suspicious had to be removed that would be significant separately identifiable but every procedure code has a little bit of reimbursement built in for an evaluation and management because we're going to take a little bit of a history and we're going to take a little bit of an exam and make some medical decisions before doing any kind of procedure on a patient even if it's something simple like a skin tag removal i actually talk about this much more in depth in that webinar that i have modifiers for the medical office you should definitely check it out so i hope this video helped provide a great general overview of modifiers and when we use them definitely let me know in the comments below if there's specific modifiers you'd like to see me do videos on and let me know also if you'd like to see me do a video on the ncci edits so when it says you can't build these two procedures together unless you use a modifier how you know what modifier to use and in what scenarios i will see you guys in the next video and until then just keep on coding on