BASIC MODIFIER GUIDELINES

1. Assign modifiers that have payment impact in the first position
2. Assign modifiers for anatomical designation in the second position
3. Assign modifiers for specific specialties if appropriate
4. Assign modifiers 80, 81 or 82 for a MD assistant at surgery in the first position.
5. Assign modifier AS for non- MD assistant at surgery in the first position.
6. Assign modifier 50 ONLY for bilateral procedures. Report the procedure code on both lines with the -50 modifier on the second procedure line.
7. Assign modifier 59 ONLY when distinct, independent and separate multiple procedures are provided. Documentation may be required to support the use of modifier 59.
8. Assign modifiers LT/RT in the second, third or fourth position if billing more than one modifier on a procedure. Information modifier only.

MODIFIERS:

25: Use when E/M service are separate, distinctly identifiable service from other services or procedures rendered. Do not use when E/M services that resulted in the decision to perform major surgery or on a surgical code

50: Bilateral procedures that are eligible for bilateral reimbursement, enter the procedure code modifier 50 on one line.

52: Use when a procedure was not completed in its entirety.

59: Use to clearly designate when distinct, independent and separate multiple procedures are provided, or when the procedure is not a component of another procedure. Documentation may be required to support the use of modifier 59.

80, 81, or 82: Use when MD performs assistant surgery. Must use same code as primary surgeon.

AS: Use when Non-MD performs assistant surgery. Must use same code as primary surgeon.

RT/LT: Can use RT/LT on any valid procedure code. Not used to indicate a bilateral procedure.