COBGC COBGC Modifiers and Special Billing 1 — Questions and Answers
Question 1: Which modifier is appended to indicate the physician provided only the intrapartum (delivery) portion of obstetric care?
- Modifier 54 (Correct answer)
- Modifier 55
- Modifier 56
- Modifier 22
Correct answer: Modifier 54
Modifier 54 indicates surgical (delivery) care only was provided, without antepartum or postpartum management.
Question 2: Which modifier indicates that only postpartum care was provided by the reporting physician?
- Modifier 55 (Correct answer)
- Modifier 54
- Modifier 56
- Modifier 79
Correct answer: Modifier 55
Modifier 55 is appended when the reporting physician provided only postpartum follow-up and did not perform the delivery.
Question 3: Modifier 22 is used when a procedure requires what additional condition?
- Substantially more work than described by the CPT code (Correct answer)
- A different performing provider
- The procedure is bilateral
- The procedure was unplanned
Correct answer: Substantially more work than described by the CPT code
Modifier 22 indicates the procedure required substantially increased effort, supporting additional reimbursement with supporting documentation.
Question 4: Which modifier indicates a procedure was performed on the left side only?
- Modifier LT (Correct answer)
- Modifier 50
- Modifier RT
- Modifier 51
Correct answer: Modifier LT
HCPCS modifier LT (Left Side) indicates a bilateral procedure was performed on the left side only.
Question 5: When a second surgical procedure is performed during the same operative session, which modifier is typically appended to the secondary procedure?
- Modifier 51 (Correct answer)
- Modifier 59
- Modifier 22
- Modifier 80
Correct answer: Modifier 51
Modifier 51 indicates multiple procedures performed during the same surgical session, triggering reduced payment for secondary procedures.
Question 6: Which modifier indicates a service or procedure is distinct and independent from other services performed on the same day?
- Modifier 59 (Correct answer)
- Modifier 91
- Modifier 57
- Modifier 25
Correct answer: Modifier 59
Modifier 59 identifies a procedure as distinct or independent from other services on the same date, often used to bypass NCCI bundle edits.
COBGC COBGC Modifiers and Special Billing 1
Which modifier is appended to indicate the physician provided only the intrapartum (delivery) portion of obstetric care?