COC Modifiers and Their Application 3

Question 1

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

Accepted Answer

A major surgery (90-day global)

Answer

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).

Question 2

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

Accepted Answer

-58

Answer

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.

Question 3

When is HCPCS modifier -GY used?

Accepted Answer

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

Answer

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

Question 4

Modifier -KX is used in Medicare billing to indicate:

Accepted Answer

Specific required documentation is on file to support medical necessity

Answer

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.

Question 5

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

Accepted Answer

-55

Answer

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

COC - Certified Outpatient Coder Practice Test

COC - Certified Outpatient Coder Practice Test

COC Modifiers and Their Application 3