Health Information Management

Tip: Keep track of new modifiers

APCs Insider, March 29, 2013

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CMS added two new modifiers to the anatomical modifiers that may be used under appropriate clinical circumstances to bypass an NCCI edit as part of the January update to OPPS:

  • LM, Left main coronary artery
  • RI, Ramus intermedius coronary artery
CMS also added two additional modifiers that coders can use to override an NCCI edit, when appropriate:
  • 24, Unrelated E/M service by the same physician during a postoperative period
  • 57, Decision for surgery
In addition, CMS added seven new modifiers for therapy and patient conditions:
  • CH, 0% impaired, limited, or restricted
  • CI, At least 1% but less than 20% impaired, limited, or restricted
  • CJ, At least 20% but less than 40% impaired, limited, or restricted
  • CK, At least 40% but less than 60% impaired, limited, or restricted
  • CL ,At least 60% but less than 80% impaired, limited, or restricted
  • CM, At least 80% but less than 100% impaired, limited, or restricted
  • CN ,100% impaired, limited, or restricted
The tip is adapted from “CMS adds significant number of new codes” in the March Briefings on APCs.



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