CODING


formed on the same day during the same encounter by the same physician.


-52 Reduced Services Use this modifier when a procedure is partially reduced or eliminated at the phy- sician’s discretion (not the same as a ter- minated procedure where you would use the -73 or -74 modifier). Medicare states “the intended use of this modifier is to report the reduction of a service with- out disturbing identification of the basic procedure.” It is used to indicate that part of the procedure was not completed or some part of a multiple-part ser- vice was not performed. Medicare only reimburses at 50 percent of the allowed amount when this modifier is used.


-58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period Use this modifier to indicate the per- formance of a procedure or service during the global period was staged. A staged procedure is when surger- ies are split up between two different cases, usually performed on different days. An example is when a patient has a deep skin cancer removed in a Moh’s procedure in one case and the follow- ing day, the patient has a skin graft pro- cedure done to close the surgical area where the skin cancer was removed.


-59 Distinct Procedural Service Use this modifier to indicate the proce- dure was distinct or independent from other procedures performed during the same case to identify procedures not normally reported together. This “sepa- rate procedure” status is a result of Cor- rect Coding Initiative (CCI edits) or “separate procedure” listing found in the CPT book and is appropriate under the circumstances or to represent a different session, different procedure or surgery, different compartment, different site or organ system, separate incision/exci- sion, separate lesion or separate injury not normally encountered or performed


on the same day by the same surgeon. This modifier may override edits in the payer’s system, which would normally deny the code—i.e., unbundling, etc.— but under special circumstances, the modifier can be used to make the ser- vice payable. Therefore, the -59 mod- ifier has a higher audit potential with Medicare and other payers. Usually, the –59 modifier is not used on the first code listed on the claim form. Claims filed with this modifier are subject to closer review by Medicare. Some Medicare plans require use


of the -76 modifier instead of using the -59 modifier when repeating the same code on a claim. For example, 26445- RT and -76 on the second tendon code 26445-76-RT, instead of -59. Some Blue Cross Blue Shield plans


require use of the -XS modifier instead of the -59 modifier in the circum- stances of unbundled codes. The -XS modifier also can be used when repeat- ing the same code on a claim for the same case, for example, when report- ing CPT 11420 as the first code and 11420-XS for another lesion removal using the same code in the same case.


-73 and -74 Terminated


Procedure Modifiers ■


Cancelled or postponed procedures


If a procedure is cancelled due to med- ical or non-medical reasons before the ASC has expended significant resources, no payment is allowed by Medicare. Do not bill in such cases.


■


Procedures terminated before anes- thesia was induced (modifier -73)


If a procedure is terminated due to medical complications after the ASC has expended significant resources and taken the patient to the OR, but before anesthesia has been induced, Medicare reim- burses at 50 percent of the allow- able. Append the –73 modifier to the CPT code for the first proce- dure that was planned but not per- formed. If the patient is only in the preop area when the case is called off, the case is not billable to Medicare.


■


Procedures terminated after anesthe- sia was induced (modifier -74)


If a procedure is terminated due to medical complications after anes-


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