What Is The 58 Modifier?

What is the 76 modifier used for?

Instructions.

Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service..

What is a 59 modifier?

The CPT Manual defines modifier 59 as follows: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.

Which modifier goes first 51 or 59?

Never use both modifier 51 and 59 on a single procedure code. If there is a second location procedure (such as a HCPCS code for right or left), use the CPT® modifier first.

What is a 79 modifier?

CPT Modifier 79. Description: Unrelated procedure or service by the same physician during the postoperative period.

Can modifiers 25 and 57 be used together?

When reporting an evaluation and management (E&M) service on the same claim with another service or procedure, you must append either modifier 25 “Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or …

What is a 52 modifier?

Modifier 52 is outlined for use with surgical or diagnostic CPT codes in order to indicate reduced or eliminated services. This means modifier 52 should be applied to CPTs which represent diagnostic or surgical services that were reduced by the provider by choice.

How do you use modifier 55?

Modifier 55 Fact SheetIndicate a physician, other than the surgeon, is billing for part of the outpatient postoperative care.Also, used by the surgeon when providing only a portion of the post discharge post-operative care.

Can modifier 58 be used in the office?

Modifier 58. Modifier 58 Staged or related procedure or service by the same physician during the postoperative period may be necessary to indicate the performance of a procedure during the postoperative period was: Planned prospectively at the time of the original procedure, or “staged;”

What is a 51 modifier?

Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the. same session. It applies to: • Different procedures performed at the same session. • A single procedure performed multiple times at different sites.

Can modifier 58 and 79 be used together?

Modifiers 58, 78, and 79 are all used in conjunction with procedures performed within the global period of another procedure.

Do add on codes need modifier 59?

“Generally speaking, we do not need to report modifier -59 on add-on codes.”

What is the Xu modifier?

Guidelines. HCPCS modifier XU indicates that a service is distinct because it does not overlap usual components of the main service. It is used to note an exception to National Correct Coding Initiative (NCCI) edits. It is effective January 1, 2015.

What is the 50 modifier?

Modifier 50 is used to report bilateral procedures that are performed during the same operative session by the same physician in either separate operative areas (e.g. hands, feet, legs, arms, ears), or one (same) operative area (e.g. nose, eyes, breasts).

What is the 57 modifier used for?

Modifier 57 should be appended to any E/M service on the day of or the day before said procedure when the E/M service results in the decision to go to surgery. This informs the payer that the physician determined the surgery was medically necessary.

How does modifier 57 affect payment?

c). By appending modifier 57 to an E/M code, you are alerting the payer that the E/M service—on either the day of, or the day before, a major surgical procedure—was the service at which the physician determined the surgery was appropriate and medically necessary, and is therefore not bundled to the surgery payment.

What is a 54 modifier used for?

Modifier Definition Modifier 54 Surgical Care Only: When 1 (one) physician or other qualified heath care professional performs a surgical procedure and another provider preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.

What is a 95 modifier?

95 Modifier Per the AMA, modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” Modifier 95 is only for codes that are listed in Appendix P of the CPT manual.

What is the 24 modifier?

Modifier 24 is appended to an evaluation and management service (never to a procedure) to indicate that an unrelated E&M service was provided by the same physician during a postoperative period.

What is a 25 modifier?

Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) is the most important modifier for pediatricians in Current Procedural Terminology (CPT®).

Can you use modifier 58 and 59 together?

If a better modifier exists, use it. In some cases, coders will append modifier -58 (staged or related procedure or service by the same physician during the postoperative period) instead of modifier -59.

Does modifier 58 reduce payment?

Modifier -58 should not alter the amount charged or paid for subsequent unrelated or staged procedures that are performed during the postoperative period of a previous procedure. Modifier -78 may drive a reduction because it is for management of a complication resulting from the previous procedure.