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23 Cards in this Set
- Front
- Back
Modifier blank is used when the procedure is terminated at the physician’s discretion.
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52
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Lisa was admitted to the outpatient surgery service for a colonoscopy. The physician attempted to perform a complete colonoscopy but, due to poor colon preparation, the physician was unable to view the entire colon and the procedure was terminated before the entire colon was viewed.
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Endoscopy
colon exploration 45378 "Numeric Section": 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) Appendix A: 52 Reduced Services Colonoscopy, abbreviated due to poor prep. 45378-52 |
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Tony was scheduled for a duodenal intubation and aspiration. He was taken to the laboratory where intubation was performed. The physician gave the patient a local anesthetic and a tube was inserted nasally and positioned in the duodenum. Before the specimen was obtained, the patient experienced severe nausea and vomiting. The physician elected to discontinue the procedure before obtaining the specimen.
PROCEDURES PERFORMED: Duodenal intubation and aspiration. |
Aspiration
duodenal 43756-43757 "Numeric Section": 43756 Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (eg, bile study for crystals or afferent loop culture) Appendix A: 53 Discontinued Procedure Duodenal aspiration, discontinued at provider discretion. 43756-53 |
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Modifier blank is to be used when the surgeon provides the surgical care only and does not provide the preoperative and postoperative care. Modifier blank is appended to the surgical code.
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54
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Suzette underwent an open reduction internal fixation of a proximal tibia fracture. The emergency room on-call surgeon performed the procedure with the preoperative and postoperative care performed by the patient’s primary care physician.
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The procedure code for the surgeon will be modified with modifier 54 to indicate the surgeon provided only the operative care.
PROCEDURE: Open reduction internal fixation of proximal tibia fracture. "CPT® Index": Fracture tibia open treatment 27535–27536, 27540, 27758, 27766, 27814, 27826–27828 "Numeric Section": 27535 Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed Appendix A: 54 Surgical Care Only Open reduction, internal fixation proximal tibial fracture, surgery only. 27535–54 |
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If one physician, the surgeon, provides only surgical care and uses modifier blank, the other providers will need to bill for pre/postoperative care associated with the operative procedure.
Modifier blank is used when the provider provides only postoperative care. Modifier blank is used when the provider provides only preoperative care. |
54, 55, and 56
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Rayshad underwent an incision and drainage of an ischiorectal abscess. The surgeon did not perform the postoperative care; the patient’s primary care doctor performed it.
When coding for the primary care physician, modifier 55 would be added to the procedure code. |
Incision and drainage
abscess rectum 45005–45020, 46040, 46050–46060 "Numeric Section": 46040 Incision and draining of ischiorectal and/or perirectal abscess (separate procedure) Appendix A: 55 Postoperative Management Only Postoperative care for I and D of ischiorectal abscess. 46040–55 |
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Austin’s primary care physician provided Austin with preoperative care prior to Austin’s surgery for laryngoscopic removal of a foreign body. Austin was admitted to the surgery center at the hospital, where he underwent a laryngoscopic removal of a foreign body by direct visualization through the scope by the ENT surgeon. Austin followed up with the ENT surgeon for postoperative care.
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When coding for the primary care physician, modifier 56 would be added to the procedure code to indicate the primary care physician did not participate in surgical or postsurgical care.
"CPT® Index": Removal foreign body larynx 31511, 31530–31531, 31577 "Numeric Section": 31530 Laryngoscopy, direct, operative, with foreign body removal Appendix A: 56 Preoperative Management Only Preoperative care only for laryngoscopic removal of a foreign body. 31530–56 |
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Example
Nathan presented to the hospital after several hours of abdominal pain. The on-call surgeon saw him and performed a comprehensive history and examination with medical decision making of high complexity. The patient was found to have acute cholecystitis. The surgeon discussed cholecystectomy surgery with the patient, including risks, benefits, potential complications and desired outcome. The patient agreed to surgery and was admitted to the hospital for an emergency laparoscopic cholecystectomy. |
Let’s code Nathan’s encounter from the standpoint of the surgeon. Evaluation and management code for this encounter is 99223 (read the detailed description in the “Numeric Section”). You will want to determine if this visit is the encounter “that resulted in the initial decision to perform the surgery.” Re-read the example.
The documentation clearly states the surgeon gave detailed information and the patient made the decision to proceed with surgery, which was accomplished on the same day that the E/M service was provided. Modifier 57 provides the additional information that this is a complex and detailed surgical decision encounter. Evaluation and management with initial decision to undergo surgery. 99223–57 Coding Challenge Do the ICD-9 diagnosis coding for this patient. What is the correct diagnosis code? DIAGNOSIS: Acute cholecystitis |
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Tiny Alicia is an infant with a body weight of 3 kg. She underwent an endoscopic percutaneous gastrostomy tube placement because of feeding problems.
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Gastrostomy tube
placement percutaneous endoscopic 43246 "Numeric Section": 43235 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 43246 with directed placement of percutaneous gastrostomy tube Code 43246 provides information about the procedure. Since the patient is under 4 kg, the addition of Modifier 63 alerts the third-party payer that the patient requires special care. Appendix A: 63 Procedure Performed on Infants less than 4kg Gastrostomy tube placement, endoscopic in infant under 4 kg. 43246-63 |
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A 65-year-old man was brought to the operating room for repair of a recurrent inguinal hernia. The patient was prepped and positioning was carried out. Before the administration of anesthesia, the patient complained of chest pain with cardiac monitor revealing ST segment changes. The procedure was cancelled.
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Hernia repair
inguinal recurrent 49520 "Numeric Section": 49520 Repair recurrent inguinal hernia, any age; reducible Appendix A: 73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia Scheduled recurrent inguinal hernia repair, canceled after prep and prior to anesthesia. 49520–73 |
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Modifiers blank are used only for Ambulatory Surgery Center Hospital Outpatient Use.
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73/74
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Administration of Anesthesia. Modifier blank is for use in the hospital outpatient setting when the service/procedure is discontinued after the administration of anesthesia
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74
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A 45-year-old man was taken to the operating room for a laparoscopic cholecystectomy. After making the portal entry incision, the anesthesiologist noticed the patient having ventricular fibrillation on the cardiac monitor. Defibrillation effort was tried two times, finally the arrhythmia abated. The procedure was cancelled pending further cardiac consultation
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Laparoscopy
cholecystectomy 47562–47564 "Numeric Section": 47560 Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy 47562 cholecystectomy Appendix A: 74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia Attempted laparoscopic cholecystectomy canceled after post administration of anesthesia. 47562–74 |
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A blank begins with general anesthesia to put a patient to sleep before the first incision in the navel is made. That is where the blank is inserted. Next, two very tiny incisions are made to accommodate two needle thin tools that are used to move the gall bladder and other abdominal structures about. Another small incision allows for the surgical tools used to perform the actual cutting and clipping of the gall bladder to be inserted.
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laparoscopic cholecystectomy
laparoscope |
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An abnormal heartbeat (blank) is any variation in the normal heartbeat. Abnormal heartbeats occur when the heart has an irregular heart rhythm, beats too fast (blank), or beats too slow (blank).
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arrhythmia
tachycardia) bradycardia |
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Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less
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PROCEDURE: Repair of a trigger finger of his left thumb.
"CPT® Index": Trigger finger repair 26055 "Numeric Section": 26055 Tendon sheath incision (eg, for trigger finger) Appendix A: FA Left hand, thumb PROCEDURE: Repair trigger finger, left thumb. 26055–FA. |
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Surgery for carpal tunnel syndrome is called a “blank” because it cuts the volar carpal ligament, thus releasing the median nerve from pressure... www.pdrhealth.com
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release
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The physician performed a right carpal tunnel release procedure on the patient
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Carpal tunnel syndrome
decompression 64721 "Numeric Section": 64716 Neuroplasty and/or transposition; cranial nerve (specify) 64721 median nerve at carpal tunnel Appendix A: RT Right side Right carpal tunnel release. 64721-RT. |
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PROCEDURE: Complete excision of nail and nail matrix of an ingrown toenail on the right great toe.
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Excision
nails 11750–11752 "Numeric Section": 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal Appendix A: T5 Right foot, great toe PROCEDURE: Complete excision of nail and nail matrix, ingrown toenail, right great toe. 11750–T5. |
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The patient was sent to us for comprehensive audiogram testing without interpretation, as the primary care provider wanted to review these himself.
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Audiologic function tests
audiometry comprehensive 0212T, 92557 "Numeric Section": 92557 Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) Comprehensive audiogram testing. 92557-TC. |
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When the study, test, or x-ray is performed this is considered the blank
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technical component.
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When the physician interprets the results of the study, test, or x-ray, this is considered the blank.
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professional component
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