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List of Modifiers Used in Medical Billing

Medical billers and coders use standard numerical codes to describe the procedures performed by physicians and other medical providers. Hospitals, clinics and private practices rely on medical billing professionals to use the correct codes and improve reimbursement rates. Medical billers use several modifiers to describe procedures and services in more detail.

  1. Modifier 22

    • Modifier 22 identifies a procedure that took more time than anticipated, or a procedure that was more complex or difficult than usual. If it takes a physician three hours to complete a procedure that usually takes one hour, the coder would use modifier 22 to request extra payment from the insurance provider. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition reports that payments usually increase by 20 to 30 percent when a physician office files a claim using modifier 22.

    Modifier 26

    • Modifier 26 separates physician services from the technical components of a procedure. Technical components of a procedure include radiology film, hospital equipment and facility usage. The professional component of a procedure usually covers the physician's interpretation of the procedure results. If a radiologist reads an x-ray and dictates a report, the coder would use modifier 26 to bill for this service.

    Modifier 47

    • When a surgeon provides general or regional anesthesia to a patient, a coder adds modifier 47 to the basic service. Coders and billers should not use this modifier if the doctor administers local anesthesia.

    Modifier 53

    • Coders use modifier 53 for procedures terminated due to life-threatening circumstances. This code does not apply if a doctor canceled the procedure before the administration of anesthesia or preparation of the surgical site. To use this modifier successfully, operative reports and cover letters must accompany the claim. The diagnosis code should give the reason why the doctor terminated the procedure.

    Modifier 62

    • Coders use modifier 62 when two physicians work together on the same procedure. This modifier allows both physicians to bill for the same procedure code. Coders should not use this code if one physician served as an assistant for another physician. Both physicians have to perform distinctive portions of the procedure.

    Modifier 63

    • The Colorado Health Information Management Association reports that coders use modifier 63 to indicate that a doctor performed a procedure on an infant weighing less than 4 kg. Since working on such a small infant presents special challenges, the use of modifier 63 slightly increases the payment for the procedure.

    Modifier 78

    • Modifier 78 indicates that the patient had to return to the operating room after the conclusion of the first procedure. This means that complications made it necessary for additional surgery. Laser suites, endoscopy suites and cardiac catheterization labs qualify as operating rooms for the use of this modifier. Minor treatment rooms, intensive care units and recovery rooms do not qualify as operating rooms.

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