The Current Procedural Terminology (CPT®) code set, developed and maintained by the American Medical Association (AMA), describes physicians' and other qualified healthcare professionals' medical services and procedures, and is also the designated code set for reporting services provided by organizations or facilities in specific circumstances. It is necessary to understand the CPT coding instructions and guidelines in order to correctly assign CPT codes.
The CPT code set uses modifiers as an integral part of its structure to communicate that a service or procedure has been altered by some specific circumstance. Modifiers are also needed to meet coding and payment policy requirements established by other insurers and government entities. This course discusses the purpose and use of modifiers with CPT codes, as well as the rules for using them. A current copy of the Current Procedural Terminology (CPT®), Professional Edition, is strongly recommended to optimize your understanding of the content covered.
Important Note
Throughout the CPT code set, use of terms such as physician or qualified health care professional/QHP is not intended to indicate that other entities may not report the service. In selected instances, specific instructions may define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency).
The codes and information in this course receive a comprehensive review annually and are updated as needed.
All Current Procedural Terminology (CPT®) codes, descriptions, and other data are copyright by the American Medical Association. All rights reserved.
The Current Procedural Terminology (CPT®) code set, developed and maintained by the American Medical Association (AMA), describes physicians' and other qualified healthcare professionals' medical services and procedures, and is also the designated code set for reporting services provided by organizations or facilities in specific circumstances. It is necessary to understand the CPT coding instructions and guidelines in order to correctly assign CPT codes. The CPT code set uses modifiers as an integral part of its structure to communicate that a service or procedure has been altered by some specific circumstance. Modifiers are also needed to meet coding and payment policy requirements established by other insurers and government entities. This course discusses the purpose and use of modifiers with CPT codes, as well as the rules for using them. A current copy of the Current Procedural Terminology (CPT®), Professional Edition, is strongly recommended to optimize your understanding of the content covered. Important Note The codes and information in this course receive a comprehensive review annually and are updated as needed. All Current Procedural Terminology (CPT®) codes, descriptions, and other data are copyright by the American Medical Association. All rights reserved.
Throughout the CPT code set, use of terms such as physician or qualified health care professional/QHP is not intended to indicate that other entities may not report the service. In selected instances, specific instructions may define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency).
“This program has been approved for 1.0000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
“This program has been approved for 1.0000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 1.0000 contact hours.
This activity is approved for 1.0000 contact hours.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Overview of Modifiers
What Are Modifiers?
Categories of Modifiers
Types of Modifiers
Use of Modifiers
NCCI-Associated Modifiers
Hospital Use of Modifiers
Professional and Technical Components
Modifier Examples: 26 and TC
Review
Section 3: Anatomical Modifiers
Anatomical Modifiers
Left, Right, and Bilateral Modifiers
Laterality Modifier Use
Review
Section 4: Anesthesia Modifiers
Anesthesia Modifiers
Commonly Used Anesthesia Modifiers
Common Anesthesia CPT Modifiers
Review
Section 5: E/M Modifiers
E/M Modifiers
E/M and Surgical Modifiers
Other E/M Modifiers
Procedures With E/M Codes
Review
Section 6: Surgical Modifiers
Surgical Modifiers
Hospital Outpatient Surgical Modifiers
Global Surgical Procedures
Co-Surgery and Surgical Teams
Surgical Procedure Modifiers
Review
Section 7: Conclusion
Course Summary
Course Contributor(s)
Resources
References
Expert Reviewer: Andrei Besleaga, BS, RHITSarah is a Subject Matter Expert/Writer for Relias's Revenue Cycle and Coding online education. Sarah is credentialed by AHIMA as a Certified Coding Specialist (CCS) and Certified Coding Specialist Physician-based (CCS-P), as well as an approved ICD-10-CM/PCS Trainer. She is also credentialed by AAPC as a Certified Professional Coding Instructor (CPC-I), a certified coder of physician/professional (CPC) and outpatient hospital services (COC), and a Certified Risk Adjustment Coder (CRC), with specialty certification in Evaluation and Management Services (CEMC). Sarah has extensive experience in both professional and facility ICD-10-CM/PCS, CPT and HCPCS coding, auditing, and revenue cycle management and as an educator of hospital and professional medical coding curriculum. She has served as Director of Physician Billing and Reimbursement for a regional health system, Manager of Coding and Compliance for a hospital and cancer center, and Business Manager of Physician Practices at a teaching hospital, as well as a coding auditor and consultant. Sarah has also authored coding textbooks and instructional resources.
Disclosure: Sarah A. Serling, CCS, CPC, CRC, COC, CCS-P, CEMC, CPC-I, ICD-10-CM/PCS Trainer has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Expert Reviewer: Arletrice A. Watkins, MHA, RHIAAndrei is a healthcare coding analyst in the CPT Education and Information Services Department at the American Medical Association, a staff writer for CPT Assistant, and a contributing author of the Principles of CPT Coding textbook. He has been a Registered Health Information Technician since 2009 and an active AHIMA member. He has gathered experience and developed skills by working in health insurance, at third-party payers, and in top-ranked national health care organizations. He completed an AAS in Health Information Technology from DeVry University in 2008 and a BS in Biology from Georgia Gwinnett College in 2015. In his spare time Andrei enjoys traveling, reading, playing the piano and the pipe organ.
Disclosure: Andrei Besleaga, BS, RHIT has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Arletrice is a senior healthcare coding analyst in the CPT Education and Information Services Department and staff writer for CPT Assistant. She supports and assists with other department projects on an as-needed basis, and she is also a contributing author of the Principles of CPT Coding. She has been with the AMA for over 14 years. She has been an educator since 2002 in health information technology (HIT) and is currently a health care administration adjunct instructor at an online university. She earned a BS in Health Information Administration from the University of Illinois at Chicago, IL, and a Masters of Healthcare Administration from the University of Phoenix, AZ. She is also certified as a registered health information administrator from the American Health Information Management Association (AHIMA), as well as an AHIMA-approved ICD-10 CM/ PCS trainer.
Disclosure: Arletrice A. Watkins, MHA, RHIA has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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