Modifiers - AAPC

CPT? Modifiers

Modifier

22

23

24

25

26

27

32

33

47

50

51

52

53

54

55

56

57

58

59

62

63

66

73

74

76

77

78

79

80

81

82

90

91

92

95

96

97

99

Description

Increased Procedural Services

Unusual Anesthesia

Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a

Postoperative Period

Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care

Professional on the Same Day of the Procedure or Other Service

Professional Component

Multiple Outpatient Hospital E/M Encounters on the Same Date

Mandated Services

Preventive Services

Anesthesia by Surgeon

Bilateral Procedure

Multiple Procedures

Reduced Services

Discontinued Procedure

Surgical Care Only

Postoperative Management Only

Preoperative Management Only

Decision for Surgery

Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

Distinct Procedural Service

Two Surgeons

Procedure Performed on Infants less than 4 kg

Surgical Team

Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia

Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia

Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

Repeat Procedure by Another Physician or Other Qualified Health Care Professional

Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following

Initial Procedure for a Related Procedure During the Postoperative Period

Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

Assistant Surgeon

Minimum Assistant Surgeon

Assistant Surgeon (when qualified resident surgeon not available)

Reference (Outside) Laboratory

Repeat Clinical Diagnostic Laboratory Test

Alternative Laboratory Platform Testing

Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

Habilitative Services

Rehabilitative Services

Multiple Modifiers

Category II Modifiers

Modifier

1P

2P

3P

8P

Description

Performance Measure Exclusion Modifier due to Medical Reasons

Performance Measure Exclusion Modifier due to Patient Reasons

Performance Measure Exclusion Modifier due to System Reasons

Performance Measure Reporting Modifier - Action Not Performed, Reason Not Otherwise Specified

HCPCS Modifiers

Modifier

A1

A2

A3

A4

A5

A6

A7

A8

A9

AA

AD

Description

Dressing for one wound

Dressing for two wounds

Dressing for three wounds

Dressing for four wounds

Dressing for five wounds

Dressing for six wounds

Dressing for seven wounds

Dressing for eight wounds

Dressing for nine or more wounds

Anesthesia services performed

personally by anesthesiologist

Medical supervision by a physician:

more than four concurrent

anesthesia procedures

Modifier

AE

AF

AG

AH

AI

AJ

AK

AM

AO

AP

Description

Registered dietician

Specialty physician

Primary physician

Clinical psychologist

Principal physician of record

Clinical social worker

Non participating physician

Physician, team member service

Alternate payment method declined

by provider of service

Determination of refractive state

was not performed in the course

of diagnostic ophthalmological

examination

Modifier

Description

AQ

Physician providing a service in

an unlisted health professional

shortage area (HPSA)

AR

Physician provider services in a

physician scarcity area

AS

Physician assistant, nurse

practitioner, or clinical nurse

specialist services for assistant at

surgery

AT

Acute treatment (this modifier

should be used when reporting

service 98940, 98941, 98942)

AU

Item furnished in conjunction with a

urological, ostomy, or tracheostomy

supply

Table of Contents

Introduction

yy Features, Symbols, and Conventions??????????? 3

Instructions for Using This Manual????????????4

Anatomical Illustrations??????????????????????????????5

¡ì Surgery/Eye and Ocular Adnexa??????????? 939

¡ì Surgery/Auditory System??????????????????????? 963

¡ì Surgery/Operating Microscope?????????????? 971

yy Radiology Procedures??????????????????????????????? 973

yy Pathology and Laboratory Procedures???? 1021

New/Revised/Deleted Codes Advice

for 2020????????????????????????????????????????????????????????41

yy Medicine Services and Procedures??????????1135

CPT? Modifiers, Definitions, and Tips??????97

yy Category III Codes?????????????????????????????????? 1243

HCPCS Modifiers, Definitions,

and Tips????????????????????????????????????????????????????109

yy Multianalyte Assays ???????????????????????????????? 1269

Index ????????????????????????????????????????????????????????177

Code Chapters??????????????????????????????????????????441

yy Evaluation and Management Services?????? 441

yy Anesthesia???????????????????????????????????????????????? 471

yy Surgery

yy Category II Codes??????????????????????????????????? 1223

yy Proprietary Laboratory Analyses????????????? 1271

Appendices

yy Appendix A: New, Revised, and Deleted

Codes for 2020???????????????????????????????????????? 1283

yy Appendix B: Crosswalks for

Deleted Codes ??????????????????????????????????????? 1285

¡ì Surgery/General???????????????????????????????????? 491

yy Appendix C: Inpatient-Only

Procedure Codes???????????????????????????????????? 1287

¡ì Surgery/Integumentary System????????????? 493

yy Appendix D: Category II Modifiers?????????? 1293

¡ì Surgery/Musculoskeletal System?????????? 533

yy Appendix E: HCPCS Level II Modifiers??? 1295

¡ì Surgery/Respiratory System????????????????? 671

yy Appendix F: Resequenced CPT? Codes??? 1303

¡ì Surgery/Cardiovascular System???????????? 695

¡ì S

 urgery/Hemic and Lymphatic

Systems????????????????????????????????????????????????? 757

¡ì Surgery/Mediastinum and Diaphragm??? 763

¡ì Surgery/Digestive System????????????????????? 765

¡ì Surgery/Urinary System???????????????????????? 829

¡ì Surgery/Male Genital System???????????????? 855

¡ì Surgery/Reproductive System??????????????? 867

¡ì Surgery/Intersex Surgery?????????????????????? 869

yy Appendix G: Vascular Families for

Interventional Radiology Coding????????????? 1305

yy Appendix H: Modifier 51 Exempt,

Modifier 63 Exempt, and Add-On Codes????1311

yy Appendix I: Brand-Name and Generic

Vaccinations Associated With

CPT? Codes???????????????????????????????????????????? 1313

yy Appendix J: Place of Service/Type of

Service???????????????????????????????????????????????????? 1315

¡ì Surgery/Female Genital System??????????? 871

yy Appendix K: Drug Class List??????????????????? 1319

¡ì Surgery/Maternity Care and Delivery???? 889

yy Appendix L: APC Status Indicators????????? 1337

¡ì Surgery/Endocrine System???????????????????? 895

yy Appendix M: ASC Payment Indicators???? 1339

¡ì Surgery/Nervous System?????????????????????? 899

Anatomical Illustrations

??17

Anatomical Illustrations

Title: Skin layers.png, Author: Madhero88, Source: Own work, License/Permission: This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.,

URL link:

Anatomical Illustrations

Anatomical Illustrations

18??

A

A (Vitamin A) 84590

A-II (Angiotensin II) 82163

Ab Externo Trabeculectomy (AET)

65850

Abbe-Estlander Reconstruction

Procedure

Lip Excision 40527

Plastic Repair With Sectioning and

Inserting Pedicle 40761

Abdomen or Abdominal

CPT? is a registered trademark of the American Medical Association. All rights reserved.

Exploration 49000, 49010

Paracentesis 49082, 49083

Peritoneal Lavage 49084

Reopening, Recent 49002

Staging/Restaging 49220

With or Without Omentectomy 58960

Injection, Air or Contrast Material 49400

Intraperitoneal

Tunneled Catheter

Exit Site 49436

Insertion 49418, 49419, 49421, 49435

Removal 49422

Revision 49325

Venous Shunt

Insertion 49425

Ligation 49428

Removal 49429

Revision 49426

Laparoscopy

Surgical 49321, 49322, 49323, 49324,

49325, 49326, 49327

Unlisted Procedure 49329

Without Treatment 49320

Laparotomy, See Also Exploratory

Laparotomy, Abdomen

Reopening, Recent 49002

Staging 49220, 58960

Ligation, Artery 37617

Lymphadenectomy (Removal) 49220

Lymphangiogram/Lymphangiography

75805, 75807

Injection 38790

Magnetic Resonance Imaging (MRI)

With Contrast Material 74182

Without Contrast Material 74181

Followed With Contrast Material 74183

Needle Biopsy (Percutaneous) 49180

Nonbiologic or Synthetic Implant 0437T

Panniculectomy, Infraumbilical 15830

Paracentesis

With Imaging Guidance 49083

Without Imaging Guidance 49082

Pelvic Exenteration (Radical Resection)

51597

Peritoneal Venous Shunt Revision 49426

Radiation Therapy Guidance Device

Placement 49411, 49412

Radiography/Imaging

CT 74150-74178

MRI 74181, 74182, 74183, 74185

Peritoneogram 74190

Ultrasound 76700, 76705

X-ray 74018-74022

Removal, Mesh/Prosthetic Material 11008

Suture, Secondary 49900

Ultrasound

Complete 76700

Limited 76705

Unlisted Procedure 49999

Wall Debridement for Infection 11005,

11006

Wound (Penetrating) Exploration 20102

X-ray, Radiologic Exam 74018-74022

??177

INDEX

Abscess Incision and Drainage

Peritoneal 49020

Retroperitoneal 49060

Subphrenic 49040

Anesthesia, See Anesthesia, Abdomen

Angiography

CT With Contrast Material 74174, 74175,

75635

Magnetic Resonance (MRA) 74185

Aorta

Angiography 75635

Aortography 75625, 75630

Thromboendarterectomy 35331

Aortic Aneurysm

Endovascular 34701-34708

Device Placement 34808

Open Repair 34832, 34841-34848,

35081-35103

Prosthesis or Graft 34813, 34820,

34709-34711

Exposure 34812

Infrarenal Repair 34830, 34831, 34832

Open Exposure 34833, 34834

Screening Ultrasound 76706

Biopsy During Exploratory Laparotomy

49000

Blood Vessel Repair

Direct 35221

With Graft 35281

With Vein Graft 35251

Bypass Graft Removal (Infected) 35907

Catheter (Tunneled) Removal 49422

Celiotomy, See Laparotomy

Cesarean Section Delivery

Delivery Only 59514, 59620

Delivery With Postpartum Care 59515,

59622

Routine Obstetric Care 59510, 59618

With Hysterectomy 59525

With Tubal Ligation 58611

CT Scan

With Contrast 74160, 74174, 74175,

74177, 75635

Without Contrast 74150, 74170, 74176,

74178

Drainage

Paracentesis

With Imaging Guidance 49083

Without Imaging Guidance 49082

Peripancreatic 48000

Skin and Subcutaneous Tissue 10060,

10061

Ectopic Pregnancy, Surgical Treatment

59130

Excision/Destruction

Cyst

5 cm Diameter or Less 49203

5.1-10.0 cm Diameter 49204

Greater Than 10.0 cm Diameter 49205

Endometrioma 49203, 49204, 49205

Tumor

Intraabdominal

5 cm or Less 49203

5.1-10.0 cm Diameter 49204

Greater Than 10.0 cm 49205

Radical Resection

5 cm and Greater 22905

Less Than 5 cm 22904

Subcutaneous (Abdominal Wall)

3 cm and Greater 22903

Less Than 3 cm 22902

Subfascial (Abdominal Wall)

5 cm and Greater 22901

Less Than 5 cm 22900

Exploration

Post-operative Hemorrhage 35840

Preperitoneal Pelvic Packing 49013, 49014

Reopening of Recent Laparotomy 49010

Staging/Restaging 49220, 58960

With or Without Biopsy 49000

Fascia Reinforcement with Nonbiologic or

Synthetic Implant 0437T

Hernia Repair

Epigastric 49570, 49572

Inguinal

5 Years or Older 49505, 49507, 49520,

49521, 49525

Laparoscopic 49650, 49651

6 Months to Less Than 5 Years 49500,

49501

Less Than 6 Months of Age 49491,

49492, 49495, 49496

Omphalocele 49600, 49605, 49606,

49610, 49611

Spigelian 49590

Umbilical

5 Years or Older 49585, 49587

Less Than 5 Years 49580, 49582

Ventral or Incisional 49560, 49561,

49565, 49566

With Mesh Implantation 49568

Hysterectomy (With or Without Salpingooophorectomy)

Radical 58210

Supracervical 58180

Total (TAH) 58150

Colpourethrocystopexy 58152

Omentectomy 58956

Partial Vaginectomy 58200

With Resection of Ovarian Malignancy

58951, 58953, 58954, 58956

Incision Procedures, See Also Laparotomy

Drainage 49020, 49040, 49060, 49062

A (Vitamin A) ¡ª Abdomen or Abdominal, X-ray

Index

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