Modifiers and Place of Service Codes for Podiatric Medical Procedures, Study notes of High Pressure Vessels and Boilers

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Modifiers and Place

of Service Codes

Presented by: Phillip Ward, DPM; CSFAC; FASPS; FACFAS

• This PowerPoint presentation is being provided as a free member benefit for APMA Young Physicians. Please be reminded that CPT code descriptors and coding policies do not reflect coverage and payment policies. The existence of a CPT code does not ensure payment for any service. The coverage and payment policies of governmental and commercial payers may vary. Questions regarding coverage and payment for an item or service should be directed to particular payers. Any coding advice in this presentation reflects the opinions of the APMA Coding Committee only. APMA disclaims responsibility for any consequences or liability attributable to the use of the information contained in this presentation. This PowerPoint is the property of the American Podiatric Medical Association. Any use not authorized in writing by the APMA, including distribution to individuals who are not members of the APMA, is strictly prohibited.

E/M Modifier

-21 Prolonged E&M Service (Perform a higher level - i.e., 99203 but spend an hour with the patient and document face to face time with patient was over half the time) -24 Unrelated E/M during post-op period CMS 1500 Block #19 put the reason why the E&M was unrelated and necessary

Compare -57 and -

• Decision for major surgery based upon the E/M done today
• Major procedure for Medicare/Medicaid
• Any procedure for commercial insurance - - Separately and identifiable E/M service on same day as a minor surgical procedure - Document your E&M well and keep any procedure documentation as a separate part of your note - Used with minor procedure for Medicare or for commercial insurance

Procedure Modifiers

-22 Unusual Procedural Service (requests a higher payment, always involves hand processing, must include documentation stating how the service exceeds usual and customary)

• 76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional (2011 Revised)

-77 Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional (2011 Revised)

-78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period (2011 Revised)

-79 Unrelated procedure by same physician during post-op period

Procedure Modifiers

Unusual Circumstances Modifiers

-73 Discontinued Outpatient Hospital / ASC Procedure prior to administration of anesthesia -74 Discontinued Outpatient Hospital / ASC Procedure after administration of anesthesia

-50 Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. (Revised 2011) Example - (perform hammertoe correction 2nd bilaterally: 28285-50-T1-T6, make sure you charge 1.5x - 2x your normal fee)

Unusual Circumstances

Modifiers

Medicare Modifiers

-A1 Dressing for one wound -A2 Dressing for two wounds -A3 Dressing for three wounds -A4 Dressing for four wounds -A5 Dressing for five wounds -A6 Dressing for six wounds -A7 Dressing for seven wounds -A8 Dressing for eight wounds -A9 Dressing for nine or more wounds

Medicare Modifiers

-GA Waiver of liability statement (ABN) on file with ABN waiver signed -GY Item or service statutorily non-covered; No need to get ABN waiver -GZ Item or service expected to be denied as not reasonable and necessary

HCPCS Modifiers

-GJ “OPT OUT” physician providing emergency / urgent care -GP Services were provided under an outpatient physical therapy plan of care -GW Service not related to hospice patient’s terminal care (used when a hospice patient is seen, but services are unrelated to the terminal condition)

HCPCS Modifiers

• AQ (replaced QB ad QU) Physician services provided in health provider shortage area (HPSA) -QW CLIA waived test

HCPCS Modifiers

-Q5 Service provided by substitute physician under reciprocal billing arrangement -Q6 Services provided by a locum tenens physician

HCPCS Modifiers

-Q7 One Class A finding -Q8 Two Class B findings -Q9 One Class B and Two Class C findings