Procedure codes may be “modified” under certain circumstances to more accurately represent the service rendered. Modifiers are used to add information or change the description of service in order to improve accuracy or specificity. The documentation of the service provided must support the use of the modifier.
Below are some commonly used modifiers with links to information from your local Medicare MAC as well as printable Decision Trees specified to the most common modifiers!
- 25 – Decision Tree – Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure.
- 26 – Decision Tree – Professional Component refers to certain procedures that are a combination of a physician component and a technical component. Using modifier 26 identifies the physician’s component.
- TC – This modifier identifies the technical component of certain services that combine both the professional and technical portions in one procedure code. Using modifier TC identifies the technical component.
- 76 – Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day.
- 77 – Repeat procedure or service by another physician or other qualified health care professional.
- 78 – Decision Tree – Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period.
- 79 – Decision Tree – Unrelated procedure by the same physician during the post-operative period.
- 50 – Bilateral Procedure; procedures/services that occur on identical, opposing structures
- 57 – Decision Tree – Decision for Surgery: add to the appropriate level of E/M service provided on the day before or day of surgery, in which the initial decision is made to perform major surgery. Major surgery includes all surgical procedures assigned a 90-day global surgery period.
- 59 – Decision Tree – Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances.
Medicare Distinct Procedural Modifiers:
- XE – Separate encounter, a service that is distinct because it occurred during a separate encounter.
- XS – Separate structure, a service that is distinct because it was performed on a separate organ/structure.
- XP – Separate practitioner, a service that is distinct because it was performed by a different practitioner
- XU – Does not overlap usual components of the main service unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service