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Surgical Modifiers Page updated: September 2020Surgical Modifiers Introduction Purpose The purpose of this module is to provide participants with an understanding of the policies and procedures of

How to fill out surgical modifiers

How to fill out surgical modifiers

1. To fill out surgical modifiers, follow these steps:
2. Determine the primary surgical procedure code for which you need to apply the modifier.
3. Identify the specific surgical modifier required for the procedure. Surgical modifiers range from -54 to -69 and can indicate different circumstances or variations in the surgical procedure.
4. Add the modifier to the surgical procedure code by appending it to the code with a hyphen. For example, if the primary surgical procedure code is 12345 and the modifier is -56, the modified code would be 12345-56.
5. Ensure that the modifier accurately represents the circumstances of the surgery and that it is supported by appropriate documentation.
6. Document the modifier code on the claim form or electronic health record to indicate the use of the surgical modifier.
7. Submit the claim or record with the completed surgical modifier information for proper billing and reimbursement.

Who needs surgical modifiers?

1. Surgical modifiers are typically needed by healthcare professionals and medical coders who are involved in billing and coding for surgical procedures.
2. Specific individuals or entities who may require surgical modifiers include:
3. - Surgeons
4. - Physicians
5. - Anesthesiologists
6. - Hospitals
7. - Ambulatory surgical centers
8. - Medical billing and coding professionals
9. Surgical modifiers help ensure accurate billing, appropriate reimbursement, and proper documentation of unique circumstances or variations in surgical procedures.

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What is surgical modifiers?

Surgical modifiers are codes used in medical billing to indicate that a surgical procedure has been altered in some way, such as by the nature of the procedure, the location, the number of procedures, or other circumstances that affect the reimbursement.

Who is required to file surgical modifiers?

Healthcare providers, including physicians and surgical facilities, who submit claims for surgical procedures must file surgical modifiers to provide accurate information about the services rendered.

How to fill out surgical modifiers?

Surgical modifiers should be appended to the corresponding procedure code on the claim form, typically on the CMS-1500 form, in the designated modifier field. Providers must ensure that modifiers are correctly applied based on the circumstances of the surgery.

What is the purpose of surgical modifiers?

The purpose of surgical modifiers is to provide additional information to payers regarding the performed surgical procedure, helping to ensure proper reimbursement and to clarify the context of the services rendered.

What information must be reported on surgical modifiers?

The information that must be reported includes the specific surgical modifier code, which indicates changes or circumstances regarding the procedure, as well as relevant details of the surgery being billed.