Health Information Management

Tip: Use procedural modifiers to further describe services

APCs Weekly Monitor, December 4, 2009

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Procedural modifiers can provide a wealth of information to further describe services provided. Coders apply these modifiers to non-E/M codes.
 
Specify location with anatomic modifiers.. These include -T1 through -T9 for each toe, -F1 through -F9 for each finger, -E1 through -E4 for each eyelid, -LC, -LD, and -RC for coronary arteries, and -LT (left) and -RT (right). Use modifiers -LT and -RT to identify procedures that can be performed on paired organs but were performed only on one side.
 
Bilateral procedures are performed on mirror-image organs or body parts during the same operating session. All CPT procedures are assumed to be unilateral unless the description specifies bilateral.
 
Modifier -50 (bilateral procedure) is one of the most frequently used anatomical modifiers. Appending modifier -50 can affect reimbursement, so always check the list of bilateral procedures by payer.
 
This tip was adapted from the article “Master modifiers to ensure accurate reimbursement” in the December issue of Briefings on APCs.



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