MBC Ch 10 Modifiers

Modifiers may affect:

• health care premiums

• type of treatment provided

• the way payment is made by a third-party payer

• all are correct

Modifiers are used to indicate what type of information?

• bilateral procedure

• multiple procedures

• service greater than usually required

• all are correct

Modifier -57, decision for surgery, is used on what type of service?

• E/M

• surgery

• anesthesia

• all are correct

Modifier -79, unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period, is used on what type of service?

• E/M

• surgery

• anesthesia

• all are correct

Modifier -51, Multiple Procedure, is used on what type of services?

• E/M

• surgery

• anesthesia

• all are correct

Modifier -80, Assistant Surgeon, is used when:

• two surgeons perform a distinct part of the surgery

• the surgery is complex and requires several physicians

• a second surgeon provides assistance to the primary surgeon

• all are correct

Modifier -32 is used to indicate a service is mandated. Which of the following is an example of when a service is "mandated"?

• Another physician requests a second opinion

• An insurance company requires a second opinion prior to surgery

• The patient requests a second opinion

• all are correct

Modifier -25, significant, separately identifiable E/M service by the same individual on the same day of the procedure or other service, is used to report an E/M service that was:

• performed in a postoperative period

• provided on the same day as a minor procedure performed by the same individual

• provided on the same day as a major procedure

• all are correct

Modifier -59, distinct procedure service, is used to indicate that:

• services that are usually bundled into one payment were provided as separate services

• a subsequent surgery was planned or staged

• a service was repeated

• a patient is taken back to the operating room for surgical treatment of a complication resulting from a previous surgery

Modifier -58, staged or related procedure or service by the same physician during the postoperative period, is used to indicate:

• a patient is taken back to the operating room for surgical treatment of a complication resulting from a previous surgery

• services provided usually bundled into one payment were provided as separate services

• a service was repeated

• a subsequent surgery was planned at the time of the first surgery