Coding Corner

MODIFIERS

MODIFIERS: 22 – Increased Procedural Service

Question: What are the documentation requirements for reporting modifier 22 (Increased Procedural Services) with procedure codes?

Answer:  According to CPT® Assistant May 2020, the documentation must support “the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physician and mental effort required).” Therefore, modifier 22 would be reported based on the physician’s increased work; and the supporting documentation should specify all the elements which contributed to the increased work.

MODIFIERS: 50 – Bilateral Procedures

Question: What are the reporting requirements for modifier 50 (bilateral procedures) with procedure codes? 

Answer:  This modifier is used to report bilateral procedures performed in the same operative session. 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 CPT® code. This modifier should not be appended to designated “add-on” codes or with surgical procedures identified by their terminology as “bilateral”.

Keep in mind not all CPT® codes allow payment for bilateral procedures. According to the Medicare Physician Fee Schedule Database, each CPT® code has specific payment indicators that correspond with specific modifier use. One of the payment indicators is for bilateral procedures:

MODIFIERS: 62 – Two Surgeons

Question: What are the reporting requirements for modifier 62 (Two Surgeons) with procedure codes?

Answer:  Modifier 62 is used to report the work of two surgeons performing distinct part(s) of a procedure, otherwise known as co-surgeons. Each surgeon should report his/her operative work by appending modifier 62 to the procedure code and any associated add-on codes for that procedure. The procedure code(s) reported by each of the co-surgeons should be identical.

Keep in mind not all CPT® codes allow payment for co-surgeons. According to the Medicare Physician Fee Schedule Database, each CPT® code has specific payment indicators that correspond with specific modifier use. One of the payment indicators is for co-surgeon:

If each surgeon performs a different procedure during the same operative session, it would not be considered a co-surgeon situation. Each surgeon would report his/her own services without use of modifier 62.

MODIFIERS: 80 – Assistant Surgeon

Question: What are the reporting recommendations for modifier 80 (Assistant Surgeon) with procedure codes?

Answer:  Modifier 80 is used to report assistant at surgery services by another surgeon in conjunction with the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (nurse practitioners or physician assistants). While it is standard practice to list the assistant surgeon’s name in the operative report header, it is recommended the documentation specify the indications for an assistant to support medical necessity (see payment indicator “0”). The documentation should also specify what services or procedures in which the assistant surgeon actually assists, particularly in a case in which multiple procedures are performed. This is to identify which CPT® procedure codes need modifier 80 appended.

Keep in mind not all CPT® codes allow payment for assistant surgeons. According to the Medicare Physician Fee Schedule Database, each CPT® code has specific payment indicators that correspond with specific modifier use. One of the payment indicators is for assistant surgeon: