thesia has been induced, Medicare should reimburse at 100 percent of the allowed amount. Append the –74 modifier to the billed CPT code if the first procedure has been started and the patient has received anesthe- sia for the case.


■ For terminated colonoscopy pro-


cedures where the scope procedure was unable to be completed—the scope did not make it to the cecum— due to poor prep, unusual anatomy, etc., use the -74 modifier with the CPT code for the scheduled proce- dure (G0121, G0105 or 45378) or the appropriate invasive procedure (45385, 45380, etc.), if done.


-76 Repeat Procedure or Service


by Same Physician Use this modifier when an identical (repeated) procedure or service is per- formed following the initial procedure or service during the global period.


-77 Repeat Procedure or Service


by Another Physician Use this modifier when a physician performs the same procedure that another


physician performed previ-


ously during the global period -78 Return to the OR


for a Related Procedure During the Postoperative Period This modifier is used when another pro- cedure is performed on a patient dur- ing the global period, which for an ASC would usually involve post-operative bleeding. Use this modifier on the code for the second or subsequent procedure performed to control the hemorrhage.


-79 Unrelated Surgery during the Postoperative Period Use this modifier on the code for the second procedure performed when an unrelated surgical procedure is per- formed during the global period of the first procedure by the same surgeon.


22 ASC FOCUS APRIL 2021 | ascfocus.org


-TC Technical Component Most X-ray, fluoroscopic guidance or ultrasound guidance procedures have a combination of a physician (reading/interpretation) component and a technical component (facil- ity side). The –TC modifier reflects that the technical component only if an X-ray or fluoroscopic, ultrasound, etc., guidance is being billed by the ASC for supplying the equipment and imaging for the procedure.


Ophthalmology, Toe and Finger Modifiers Do not use –RT or –LT modifiers with these modifiers. The -59 modi- fier is not necessary unless more than one procedure—which is unbundled in the CCI material—is performed on the same eyelid, toe or finger, but it is separately billable because it was per- formed through a separate incision or in a separate area. The finger and toe


modifiers are not used when the pro- cedures are performed on the meta- tarsal or metacarpal areas or below. These are for use for procedures per- formed on the phalanx areas.


According to Current Procedural Terminology guidelines, not using required modifiers when necessary can cause unnecessary claim denials.”


—Stephanie Ellis, RN, mdStrategies


-SG Surgery Center Modifier For dates of service January 1, 2008, going forward, -SG Modifiers are no longer needed on most Medicare ASC claims. This modifier is usually used now on claims filed to some payers on CMS-1500 claim forms, such as state Medicaid claims. It is not necessary to use the –SG modifier on most claims filed on UB-04 claims going to other payers, unless the payer requires it. Do not use the –SG modifier on Health- care Common Procedure Coding Sys- tem (HCPCS) codes billed for implants or radiology codes.


Cardiology Modifiers Cardiology modifiers are used on such procedures as heart catheterizations and are listed below: -LC Left Circumflex Coronary Artery


-LD Left Anterior Descending Coronary Artery


-LM Left Main Coronary Artery -RC Right Coronary Artery -RI Ramus Intermedius Coro- nary Artery


Knowing which modifiers to use,


how to use them and when to use them can be confusing, but is important to get your arms around, because it can have a significant affect on your ASC’s reimbursement. It is as important for the modifiers used to be correct as it is that the procedure itself is coded cor- rectly, because using modifiers incor- rectly can cost you money and cause a compliance risk for your facility.


Stephanie Ellis, RN, is a coding manager of mdStrategies in Houston, Texas. Write her at sellis@mdstrategies.com.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34