HITT 2335 Chapter 3 - Modifiers Part 1 Exam Questions Answered Correctly Rated A+
INTRODUCTION - Answers For purposes of instruction and for ease in reading, this book uses a dash to
separate each five-character Current Procedural Terminology (CPT) code from its two-character
modifier.
However, dashes are not used in actual code assignments and reimbursement claims, which report
seven-character codes with no spaces between the characters when the assignment of modifiers is
appropriate.
Modifiers may be reported along with a CPT code to indicate that a particular event modified the
service/procedure, but with no change to its basic definition.
USE OF MODIFIERS - Answers Modifiers may indicate any of the following situations:
A service/procedure has both a professional component and a technical component.
A service/procedure was performed by more than one physician or in more than one location.
A service/procedure has been increased or reduced in scope.
A service was performed only partially.
An adjunctive service was performed.
A bilateral procedure was performed.
A service/procedure was performed more than once.
, An unusual event occurred during the service/procedure.
MODIFIERS - There is a distinct advantage to conveying as much information as possible to the third-
party payer to ensure appropriate payment when - Answers billing for professional physician services or
services provided by an ambulatory surgery or service center.
Use of a modifier, in selected cases, allows the healthcare provider to - Answers explain special
circumstances that surround the charge for the service and may affect claim payment
Use of an appropriate modifier also can prevent a - Answers claim from being denied.
When using modifiers, it is important to note that an individual third-party payer may - Answers have
their own policies for reporting modifiers.
Appendix A of the CPT code book includes a complete list of - Answers currently accepted modifiers and
their descriptions.
Coding professionals should examine modifier descriptions carefully for conditions that may - Answers
limit use of a modifier to a specific section of CPT.
For example, modifier 25 is limited by definition to evaluation and management codes and would not be
appended to a code from the surgery section.
Modifier 78 (Return to Operating Room for a Related Procedure During the Postoperative Period) would
only be appended to a CPT surgical code.
The CPT and Healthcare Common Procedure Coding System (HCPCS) systems for describing and
reporting medical procedures - Answers and services include the use of special supplementary codes
called modifiers.
Modifiers are two-character codes that can be appended to some of the CPT Level I codes - Answers and
the HCPCS Level II codes to provide additional information.
Different sets of modifiers apply to different services and - Answers settings
For example, two-digit numerical modifiers can be appended to CPT codes for - Answers reporting
additional information relevant to physician and outpatient hospital services.
In addition, two-digit alphabetic or alphanumeric modifiers permit more concise reporting of services in
- Answers Level II (National) HCPCS codes.
In most cases, modifiers applicable to the codes for physician services are simply appended to the -
Answers appropriate CPT code, as in the following example:
INTRODUCTION - Answers For purposes of instruction and for ease in reading, this book uses a dash to
separate each five-character Current Procedural Terminology (CPT) code from its two-character
modifier.
However, dashes are not used in actual code assignments and reimbursement claims, which report
seven-character codes with no spaces between the characters when the assignment of modifiers is
appropriate.
Modifiers may be reported along with a CPT code to indicate that a particular event modified the
service/procedure, but with no change to its basic definition.
USE OF MODIFIERS - Answers Modifiers may indicate any of the following situations:
A service/procedure has both a professional component and a technical component.
A service/procedure was performed by more than one physician or in more than one location.
A service/procedure has been increased or reduced in scope.
A service was performed only partially.
An adjunctive service was performed.
A bilateral procedure was performed.
A service/procedure was performed more than once.
, An unusual event occurred during the service/procedure.
MODIFIERS - There is a distinct advantage to conveying as much information as possible to the third-
party payer to ensure appropriate payment when - Answers billing for professional physician services or
services provided by an ambulatory surgery or service center.
Use of a modifier, in selected cases, allows the healthcare provider to - Answers explain special
circumstances that surround the charge for the service and may affect claim payment
Use of an appropriate modifier also can prevent a - Answers claim from being denied.
When using modifiers, it is important to note that an individual third-party payer may - Answers have
their own policies for reporting modifiers.
Appendix A of the CPT code book includes a complete list of - Answers currently accepted modifiers and
their descriptions.
Coding professionals should examine modifier descriptions carefully for conditions that may - Answers
limit use of a modifier to a specific section of CPT.
For example, modifier 25 is limited by definition to evaluation and management codes and would not be
appended to a code from the surgery section.
Modifier 78 (Return to Operating Room for a Related Procedure During the Postoperative Period) would
only be appended to a CPT surgical code.
The CPT and Healthcare Common Procedure Coding System (HCPCS) systems for describing and
reporting medical procedures - Answers and services include the use of special supplementary codes
called modifiers.
Modifiers are two-character codes that can be appended to some of the CPT Level I codes - Answers and
the HCPCS Level II codes to provide additional information.
Different sets of modifiers apply to different services and - Answers settings
For example, two-digit numerical modifiers can be appended to CPT codes for - Answers reporting
additional information relevant to physician and outpatient hospital services.
In addition, two-digit alphabetic or alphanumeric modifiers permit more concise reporting of services in
- Answers Level II (National) HCPCS codes.
In most cases, modifiers applicable to the codes for physician services are simply appended to the -
Answers appropriate CPT code, as in the following example:
