Modifiers and Their Application Flashcards

Modifier -57 is used when an E/M service results in the initial decision to perform:

Answer: A major surgery (90-day global)

Modifier -57 is appended to an E/M code when that visit is the occasion where the physician makes the initial decision to perform major surgery (90-day global period).

Which modifier is used to report a staged or related procedure performed by the same physician during the postoperative period?

Answer: -58

Modifier -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period) is used when a staged, related, or more extensive procedure is performed by the same physician during the global period.

When is HCPCS modifier -GY used?

Answer: To indicate a service is not covered by Medicare or Medicaid and is statutorily excluded

Modifier -GY is used to indicate that an item or service is non-covered or statutorily excluded by Medicare or Medicaid.

Modifier -KX is used in Medicare billing to indicate:

Answer: Specific required documentation is on file to support medical necessity

Modifier -KX attests that the specific coverage criteria for the billed item or service have been met and that the required documentation is on file.

Which modifier is used to report postoperative management only when the surgeon and postoperative care physician are different?

Answer: -55

Modifier -55 (Postoperative Management Only) is used by the physician who provides only the postoperative care after another physician performed the surgery.

Modifier -GA is a HCPCS modifier used to indicate:

Answer: A waiver of liability statement is on file

Modifier -GA indicates that a waiver of liability statement has been obtained and is on file, required when a service is expected to be denied as not medically necessary.

When two or more physicians each perform a portion of a surgical team procedure, the appropriate modifier is:

Answer: -66

Modifier -66 (Surgical Team) is used when highly complex procedures require the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel.