By DeVry University
September 25, 2023
5 min read
September 25, 2023
5 min read
If you’re preparing to pursue a career in medical billing and coding, you should familiarize yourself with modifiers in medical billing. Modifiers are an essential tool used in medical billing and coding, and just one of several aspects that are important to learn.
In this article, we will answer the question, “What is a modifier in medical billing?” by defining code modifiers and examining their different types, how they’re used and the advantages they deliver to healthcare providers as they enable a greater degree of accuracy and specificity in reporting.
Submit cleaner and more accurate claims, thereby avoiding claim denials.
Obtain the proper reimbursements by submitting claims that contain a higher level of specificity in coding.
Improve reimbursements for services that have been rendered at the same time or in an unusual manner, depending on the complexity of the case.
25: Significant, separately identifiable evaluation and management service by the same physician or other healthcare professional on the same day of the procedure or other service
26: Modifier 26 is used to bill the component of a service when it has both professional and technical components. In radiology services, for example, the physician’s note on the scan is considered to be the professional component, while the machinery used is the technical component.
59: Modifier 59 is used to specify distinct procedural services. These services are different or impartial from other non-evaluation and management services that were performed on the same day.
E1: Upper left, eyelid
TC: Technical component; under certain circumstances, a stand-alone charge may be made for the technical component of certain procedures, such as X-rays that are billed by portable X-ray suppliers.
XS: Separate structure, a service that is distinct because it was performed on a separate anatomical structure, such as an organ.
Pricing modifiers, also called payment-impacting modifiers, cause a change in pricing for the code reported.
Informational modifiers, also called statistical modifiers, are any modifiers that are not pricing modifiers, and appear after pricing modifiers on claims.
GT or 95: Used to code all of the diagnoses, evaluation or treatment of symptoms via telemedicine, this modifier is used only when the service is offered via an interactive audio and video telecommunication system.
24: This modifier is appended to unrelated evaluation or management service offered during the post-operative period of a major surgery performed within 90 days by the same physician.
51: Used when multiple procedures or surgeries are offered by the same provider during the same surgical session, including diagnostic imaging services offered during the surgical session.
27: This modifier is used when a patient is offered multiple evaluation and management services at different outpatient facilities, such as the emergency room, a pharmacy or primary clinic on the same day, by the same physician or different physicians.
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