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St. Johns River State College *

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2255C

Subject

Computer Science

Date

Dec 6, 2023

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docx

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Uploaded by ProfessorRabbit3417

HIM2255C PROMPT: Define modifiers, describe how modifiers are used, discuss the differences between hospital-only and physician-only modifiers. ANSWER: The term ‘modifier’ when used regarding CPT or HCPCS coding refers to a two-character code (numeric for CPT, alphanumeric for HCPCS Level II) code that is added to the end of a complete code. There is no space, dash, or period used between the code and the modifier, the modifier is simple appended to the code, creating a new code. The modifier is used to give more information on a procedure for billing purposes; for example, a procedure might have been bilateral and would need the modifier 50. The modifier can also list special circumstances that occurred, such as two distinct procedures occurring on the same day at the same visit, which affect the billing costs. The modifier is intended to give a reason for the way the visit was coded so there are less denied claims. It is important to know which setting you are coding for (physician or hospital) because there are separate modifiers for each type of encounter. The modifiers for use when coding for a hospital are called “Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use” and are found in Appendix A (Smith, 2021). This is an invaluable resource because it contains the precise definitions needed to correctly assign the modifiers as well as reminders as to which modifiers are used for each circumstance. CareerStep Help community. (n.d.). https://careerstep.my.site.com/s/article/CPT-Modifiers-Physician-vs-Facility Smith, G. (2021). Basic CPT and HCPCS Coding 2021.

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