Wiki Codify - List of Modifiers

[ashlyn26]

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.

• 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

 

[Deborah Marsh]

Hi – Good question. The list of modifiers is based on the AAPC CPT® to modifier crosswalk, which maps modifiers to codes that may accept the modifier. It is a coding tool, but of course the crosswalk does not guarantee payment, and payers can each have their own rules about modifier use.

For your particular example, although it seems strange based on the code descriptor, the current Medicare physician fee schedule has indicator 0 for 97164 under Asst Surg. Indicator 0 means the payment restriction usually applies, but supporting documentation of medical necessity may overcome that.



If you see other combinations you have questions about, you also can use the Codify Feedback form (top menu of Codify) or email codify@aapc.com. Thanks!