“If it isn’t coded, then it hasn’t been done.”
Correctly applying modifiers, though, isn’t always as easy as it seems. Many times providers inappropriately use modifiers, an action that inevitably can lead to claim denials.
“Modifiers are essential tools in the coding process,” says Laura Reeds, director of coding compliance at IASIS Healthcare in Franklin, Tenn. “They clarify how things should be paid … and further explain or qualify a CPT code.”
CPT modifiers (also called Level I modifiers) supplement information or adjust care descriptions to provide extra details about a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition.
Let’s take a look at 3 commonly misused modifiers, and see how they’ve been applied to different care situations.
CPT Manual defines modifier 59 as a