Stay in Your Lane, Modifiers
Question: I’m new to medical coding and still don’t fully understand the role of modifiers; do they change the code descriptors? RCI Subscriber Answer: No. A modifier doesn’t change the code descriptor at all, but it does alter the intention of the code or add more information for the payer. Modifiers are normally used when there is a special circumstance being applied to the code you are reporting. In simpler terms, modifiers are two-character codes that are used alongside CPT® and HCPCS Level II codes. They don't change the basic description of the service provided, but they add extra information to explain specific circumstances or exceptions related to the service. They essentially provide more context to the basic code description. When modifiers are used correctly, they can clarify to the payer why certain codes that aren’t normally billed together are being billed together. Modifiers serve many purposes — they can be used to offer more details about a medical service or procedure, they can specify elements such as the exact body part that was involved, in the case of HCPCS Level II modifier E1 (Upper left, eyelid) for example. Modifiers can be used to tally the count of medical professionals who carried out the procedure in the case of CPT® modifier 62 (Two surgeons), or, if there were multiple procedures performed, in which case you would use CPT® modifier 51 (Multiple procedures), just to name a few. Lindsey Bush, BA, MA, CPC, Development Editor, AAPC
