Introduction to CPT Modifiers

Dr. Kambou introduces the concept of CPT modifiers, emphasizing the importance of understanding the two types of modifiers that can be used with CPT codes. The first type is the CPT modifiers, which are part of the Level I HCPCS code set and can be found in the CPT manual. The second type is the National modifiers (RT, LT, etc.) from the Level II HCPCS code set, which can also be used with CPT codes. Dr. Kambou advises that the list of Level II modifiers can be downloaded from the CMS website, as they are maintained by CMS, unlike CPT codes which are managed by the AMA. The focus of the video is on CPT modifiers, specifically modifiers 22 through 99.

The video delves into the reasons for using modifiers, explaining that they indicate a service or procedure has been altered by specific circumstances without changing the code itself. Modifiers help the healthcare community respond to payment policy requirements and can prevent claim denials. Dr. Kambou provides examples of modifier usage, such as Modifier 22 for increased procedural services, Modifier 23 for unusual anesthesia, and Modifier 20 for unrelated evaluation and management services during the post-operative period. Each example is explained with a scenario to illustrate the modifier's application.

Dr. Kambou continues the discussion on CPT modifiers, focusing on modifiers 25 to 33. Modifier 25 is for significant separately identifiable evaluation and management services on the same day as the procedure. Modifier 26 is for the professional component of a service, such as the interpretation of an x-ray. Modifier 32 covers mandated services, while Modifier 33 is for preventive services in accordance with the US Preventive Services Task Force ratings. Modifier 47 is used when a surgeon administers anesthesia, and Modifier 50 is for bilateral procedures on paired organs, with clarifications on its appropriate use.

This section covers modifiers 51 to 56, which relate to multiple and discontinued procedures. Modifier 51 is used for additional procedures performed at the same session, with the primary procedure reported without a modifier and additional procedures marked with modifier 51. Modifier 52 is for reduced services, where the service provided was less than what the code describes. Modifier 53 is for discontinued procedures, where a procedure is started but not completed due to patient well-being. Modifier 54, 55, and 56 are related to the surgical package, with 54 for the surgeon performing the procedure only, 55 for post-operative management only, and 56 for preoperative management only.

Dr. Kambou discusses modifiers 57 to 66, highlighting their specific uses. Modifier 57 is for the decision for surgery, indicating the E&M service that led to the initial decision to perform surgery. Modifier 58 is for staged or related procedures during the post-operative period. Modifier 59 is for distinct procedural services, which are separate from other non-E&M services performed on the same day. Modifiers 62 to 66 cover scenarios involving multiple surgeons, with 62 for two surgeons working as primary surgeons, 63 for procedures on infants less than four kilograms, 66 for a surgical team involved in a highly complex procedure, and 76 and 77 for repeat procedures by the same or different professionals.

In this part, Dr. Kambou explains modifiers 78 to 82, which pertain to post-operative and unplanned circumstances. Modifier 78 is for an unplanned return to the operating room during the post-operative period for a related procedure. Modifier 79 is for a related procedure during the post-operative period by the same person, which is different from modifier 24. Modifiers 80, 81, and 82 relate to assistant surgeons, with 80 for an assistant surgeon, 81 for a minimal assistant surgeon, and 82 for a situation where a qualified resident surgeon is not available, commonly seen in teaching hospitals.

The final set of modifiers discussed are 90 to 97. Modifier 90 is for reference or outside laboratory services, indicating that the laboratory procedures are performed by a party other than the treating physician. Modifier 92 is for repeat clinical diagnostic laboratory testing on the same day for subsequent results. Modifier 95 covers synchronous telemedicine services rendered via real-time interactive audio and video telecommunications systems. Lastly, modifier 96 and 97 are for habilitative and rehabilitative services, respectively, focusing on skill development and improvement for daily living.

Dr. Kambou concludes the video with a recap of the CPT modifiers from 22 to 99, emphasizing their importance in accurately describing medical services and ensuring proper reimbursement. The video serves as an introduction to these modifiers, providing basic guidelines and examples for their use in various medical scenarios.