Wiki Modifiers for unlisted codes

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The CPT code book conflicts with instructions from CMS regarding the use of modifiers with unlisted codes. The CPT book indicates that a modifier should not be appended to unlisted codes since there is no need to alter the definition of an unlisted code because the code does not describe any particular service. However, CMS proposes that the modifier is not altering the meaning of the code, but rather providing additional information. Would anyone know where I can find concrete information on if any modifiers can be used on Unlisted codes or can we never use them?
Thanks,
 
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I would not use modifiers such as -22, -52, -53 on an unlisted, as you should be comparing the unlisted to a similar value code.
In a situation of an assistant surgeon, then I think -80 would certainly be appropriate.
Per this guidance from Optum coding:
MODIFIERS AND UNLISTED CODES
As previously discussed, a modifier is the method used by the reporting physician to indicate or flag a service or procedure code regarding special circumstances affecting that service without changing the service or procedure description itself. It should be noted that when a procedure is performed that cannot be assigned to a specific CPT code and the provider must assign an unlisted code, the CPT code book conflicts with instructions from CMS regarding the use of modifiers with unlisted codes. The CPT book indicates that a modifier should not be appended to unlisted codes since there is no need to alter the definition of an unlisted code because the code does not describe any particular service. However, CMS proposes that the modifier is not altering the meaning of the code, but rather providing additional information.
For example, IOM Pub 100-04, chapter 12, section 30.6.10, states: “Unlisted evaluation and management service (code 99499) shall only be reported for consultation services when an E/M service that could be described by codes 99251 or 99252 is furnished, and there is no other specific E/M code payable by Medicare that describes that service.” CMS further states that “the principal physician of record shall append modifier ‘-AI’ (Principal Physician of Record), in addition to the E/M code.” Other valid modifiers that may be required by Medicare that depend on the circumstances include AK, AR, CR, GC, GF, GJ, GR, GY, GZ, Q5, and Q6.
Circumstances in which modifiers may be assigned with unlisted CPT codes are also found in the Medicare physician fee schedule (MPFS). The MPFS includes columns for multiple procedures, bilateral surgeries, assistant surgeons, co-surgeons, and surgical teams. Over 150 unlisted CPT codes have at least one modifier assigned in the MPFS. In addition, modifiers TC (Technical Component) and 26 (Professional Component) are assigned to radiology, laboratory, and medicine unlisted codes (for example, 76499, 76999, 88199, 91299, and 92499).
In addition to modifiers 26 and TC, MPFS includes guidance on the following modifiers: 50, 51, 62, 66, 80, 81, 82, and AS.
 
Thank you for this information, I will go look into this more. What about the global modifiers to alert the insurance that the patient is coming back for a procedure in the global period. Such as: 58, 78,79?
 
If the patient was in a global period from another surgery and then had a procedure that needed unlisted, I would use those. I interpret the conflicting guidance as to not use modifiers that adjust whether you did more/less work, as you would simply be requesting more/less reimbursement by your description and benchmark on the unlisted. Other types of modifiers, I would use.
 
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