Current Procedural Terminology (CPT) Modifiers

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The Current Procedural Terminology (CPT) Modifiers are typically codes of two characters each that are used for clarifying and adding details to the original description of any procedure code. They may be a requirement at times along with the code of the particular procedure in use or the service provided to the patients. The modifier many a time serves to give an explanation to a third-party payer related to whatever reimbursement that the physician or hospital is going to get. The modifiers used for when a patient receives health care services as an out-patient from a hospital, and when they receive them from a physician, are different from each other.

Following are some examples of modifiers that apply to hospital outpatients: modifiers number 73 (Discontinued outpatient procedure before anesthesia administration) and 74 (Discontinued outpatient procedure after anesthesia administration). For physicians, there are various modifiers such as modifier 52 (Reduced Services) and 53 (Discontinued Procedure). Modifier 73 is used when already-scheduled services to be performed are cancelled or reduced, either before or after anesthesia. Modifier 74 would be used for these circumstances by the ambulatory surgical center in outpatient and surgical preparation. Modifier 52 shows certain circumstances in which a service or procedure is wholly or partially eliminated at the discretion of the physician or other medical professional. Modifier 53 is for use when the physician or other medical professional chooses to end a diagnostic or surgical procedure due to mitigating circumstances or situations threatening the patient’s well-being. This modifier is not to be utilized for reporting the intentional cancellation of a procedure before anesthesia or surgical preparation.

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