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digital format. The notes cover Medical Coding Modifiers, specifically focusing on E/M
(Evaluation & Management) and Surgical Modifiers.
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1. Post-Operative & Global Period Basics
* 99024 (Post-operative Visit):
* Used for follow-up visits included in the Global Surgical Package (GSP).
* These services should not be billed with a charge; they are for reporting purposes.
* Rule: If a patient comes for follow-up related to the surgery during the global period, report
99024.
* Exception: If the patient comes after the global days are over, report with the appropriate
E/M code.
* Example:
* Patient is in the global period of an Appendectomy.
* Visit for surgical follow-up \rightarrow 99024.
* (If outside global period \rightarrow Bill E/M).
2. E/M Modifiers (Evaluation & Management)
Modifier 24: Unrelated E/M During Global Period
* Definition: Unrelated E/M service by the same physician during a post-operative period.
* Usage: Used when a patient comes in during the global period of a surgery for a different
issue (unrelated to the surgery).
* Example:
* 01/01: Appendectomy (Code 44444) - Global period starts.
* 02/14: Patient returns with Leg Pain / Neck Pain / Ear Infection (Unrelated to appendix).
* Coding: 99213 - 24 (Diagnosis: Leg Strain).
Modifier 57: Decision for Major Surgery
* Definition: Decision for major surgery (usually 90-day global period).
* Usage: The E/M service resulted in the initial decision to perform the surgery.
* Example:
* Patient presents with abdominal pain. Physician confirms appendicitis and decides to
perform an appendectomy immediately.
* Coding:
* 99999 - 57 (E/M Visit)
* 44444 (Appendectomy Procedure)
Modifier 25: Separately Identifiable E/M Service
* Definition: Significant, separately identifiable E/M service by the same physician on the same
day of the procedure or other service.
* Usage: Used with Minor Procedures (0 or 10-day global period).
* Note: Usually applicable to minor procedures, except the 70/80/90 thousand series codes in
some contexts.
* Example:
* 99999 - 25 (E/M)
* Plus a minor procedure:
* Biopsy (11102)
 * Excision
* Intramuscular Injection (96372)
* Vaccination (90471)
Modifier 27: Multiple E/M Services
* Definition: Multiple outpatient hospital E/M encounters on the same date.
* Usage: Used when multiple E/M services are done for the patient on the same day (e.g.,
different clinics/specialties).
3. Teaching & Supervision Modifiers
Modifier GC: Resident + Teaching Physician (MD)
* Definition: Service performed in part by a Resident under the direction of a Teaching
Physician.
* Requirements:
* Resident treats the patient with guidance from the MD.
* Signatures of both MD and Resident are required.
* Look for an Attestation Statement in the documentation.
* Coding: 99999 - GC
Modifier GE: Resident Without Guidance
* Definition: Service performed by a Resident without the presence of a Teaching Physician
(Primary Care Exception).
* Usage: Only applicable in certain primary care centers.
* Coding: 99999 - GE
4. Split / Shared Services (Modifier FS)
* Definition: Split or Shared E/M visit.
* Parties Involved: MD + Clinical Staff (NP / CRNP / PA).
* Rule: To determine who bills, look at the Substantive Portion of Time. The provider performing
greater than half (>50%) of the total time bills for the service.
* Coding: Append modifier FS to the E/M code.
Examples:
* MD Bills:
* MD time: 20 min
* NP time: 15 min
* Total: 35 min
* Result: MD time is >50%. Bill under MD \rightarrow 99999 - FS
* NP Bills:
* MD time: 10 min
* NP time: 20 min
* Total: 30 min
* Result: NP time is >50%. Bill under NP \rightarrow 99999 - FS
(Note: If time is missing, look for the substantive portion of Medical Decision Making or
History/Exam depending on current year guidelines, though notes specifically emphasize Time).
5. Telehealth & COVID Modifiers
* Modifier CS: Cost of Service (COVID-19).
* Waives cost-sharing for E/M services that result in a COVID test order.
* Example: E/M + COVID Test \rightarrow 99999 - CS.
 * Modifier 93: Telehealth Audio Only. (Accepted by both Commercial & Medicare).
* Modifier 95: Telehealth Audio/Video. (Used for Commercial Insurance).
* Modifier GT: Telehealth Audio/Video. (Used for Medicare).
6. Surgical & Procedural Modifiers
Modifier 50: Bilateral Procedure
* Used when a procedure is performed on both sides (Right and Left).
* Example: Code - 50. (Alternatively LT and RT depending on payer).
Modifier 51: Multiple Procedures
* Usage: Physician performs multiple procedures at different anatomical sites or different
systems.
Modifier 59: Distinct Procedural Service
* Usage: Physician performs different types of procedures for different medical necessity
(conditions/diseases) or separate anatomical systems.
* Example:
* Right Ear: Wax removal with instrument. \rightarrow 69210 - RT
* Left Ear: Wax removal (lavage/irrigation, no instrument). \rightarrow 69209 - LT - 59
Modifier 52: Reduced Services
* Usage: Physician decides to perform a complete procedure, but it is partially
reduced/stopped.
* Example: Complete colonoscopy planned, but physician finds a polyp in the descending colon
and stops there (does not view full colon). \rightarrow Append 52.
Modifier 53: Discontinued Procedure
* Usage: Physician discontinues the procedure due to patient health risks or complications
(e.g., drop in BP, heart rate issues) after anesthesia/start.
7. Global Surgical Modifiers (Planning & Unplanned)
Breakdown of Global Package (Split Care):
* Modifier 54: Surgical Care Only (Intra-operative).
* Modifier 55: Post-operative Management Only.
* Modifier 56: Pre-operative Management Only.
Modifier 58: Staged or Related Procedure
* Definition: Planned procedure or staged procedure during the post-op period.
* Example:
* 01/01: Mastectomy (Major).
* 02/01: Breast Reconstruction (Planned to happen later).
* Coding: Reconstruction code + 58.
Modifier 78: Unplanned Return to OR
* Usage: Return to the operating room for a related procedure during the post-op period
(usually for complications).
* Example: Bleeding or infection after surgery requiring a return to the OR.
Modifier 79: Unrelated Procedure
* Usage: Unrelated procedure or service by the same physician during the post-op period.
* Key: The new procedure is for a totally different condition/diagnosis than the original surgery.
Modifier 76: Repeat Procedure (Same Physician)
* Usage: Repeated procedure by the same physician.
* Example: Performing multiple Chest X-rays in a single day to monitor progress.
Modifier 77: Repeat Procedure (Another Physician)
* Usage: Repeated procedure performed by another physician.
8. Anatomical Modifiers
* Fingers:
* Left Hand: FA, F1, F2, F3, F4.
* Right Hand: F5, F6, F7, F8, F9.
* Toes:
* Left Foot: TA, T1, T2, T3, T4.
* Right Foot: T5, T6, T7, T8, T9.
Summary of Modifiers List found in notes:
* 24, 25, 27, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 76, 77, 78, 79.
* GC, GE, FS, CS, GT, 93, 95.