ashlyn26
New
This question is specific to Codify. With every code that is entered, a list of modifiers appears. The list changes based upon the code entered. I have noticed, however, that not all of the modifiers are even relevant to the entered code. My question is what the list of modifiers is and should it be relied upon as actual modifiers applicable to the code entered? For example, 97164 is entered. The list of modifiers includes modifier 80 (not relevant to this code). It does not include 25 or 50 (also not relevant to this code), but it does include modifier CQ and 59. So, why would 80 be listed & not 25 or 50 when all three are not applicable to 97164. Essentially, what is the relevance of the list of modifiers? In a perfect world, it would make sense for the list to show modifiers only relevant to the code entered.....
If it is just showing a list of all of the modifiers in general, why does the list change based upon the code entered? I hope that makes sense! Thank you in advance for your help!
Modifier Crosswalk - ASC, ASC & P, P
Key: The Description color indicates which entity(ies) is (are) allowed to bill the modifier.
If it is just showing a list of all of the modifiers in general, why does the list change based upon the code entered? I hope that makes sense! Thank you in advance for your help!
Modifier Crosswalk - ASC, ASC & P, P
Key: The Description color indicates which entity(ies) is (are) allowed to bill the modifier.
- ASC (Ambulatory Surgery Center Hospital Outpatient Use)
- ASC and P (Ambulatory Surgery Center and Physician)
- P (Physician or Professional)
Modifier | Description |
27 | Multiple Outpatient Hospital E/M Encounters on the Same Date |
32 | Mandated Services |
51 | Multiple Procedures |
59 | Distinct Procedural Service |
76 | Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional |
77 | Repeat Procedure by Another Physician or Other Qualified Health Care Professional |
79 | Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period |
80 | Assistant Surgeon |
81 | Minimum Assistant Surgeon |
82 | Assistant Surgeon (when qualified resident surgeon not available) |
95 | Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System |
96 | Habilitative Services |
97 | Rehabilitative Services |
99 | Multiple Modifiers |
AG | Primary physician |
AK | Non participating physician |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |
CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant |
CR | Catastrophe/disaster related |
G0 | Telehealth Services For Diagnosis, Evaluation, Or Treatment, Of Symptoms Of An Acute Stroke |
GA | Waiver of liability statement issued as required by payer policy, individual case |
GC | This service has been performed in part by a resident under the direction of a teaching physician |
GP | Services delivered under an outpatient physical therapy plan of care |
GQ | Via asynchronous telecommunications system |
GT | Via interactive audio and video telecommunication systems |
J5 | Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service |
KX | Requirements specified in the medical policy have been met |
PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days |
Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) |
ST | Related to trauma or injury |
XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |