CPT4 Modifier

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Description

The CPT4 Modifier dictionary contains modifiers valid for E/M coding and procedures. The CCI Modifier checkbox enables that modifier to be a selectable option/modifier when the CCI Edits option has been enabled. This modifier would be selectable in the CCI edits page to apply if a CCI edit is detected by the edit tables, provided by 3M. The organization will need to synchronize changes between these two systems after the initial load. This dictionary is called from: TouchWorks Charge Encounter Form TouchWorks Charge PDA Encounter Form


Definition

CPT4 Modifier1.jpg

  • Code - The Code is a unique identifier that must be supplied. This is not displayed in the product and is used for identification purposes only.
  • Name - This is the name that will appear for the end users in the EHR application. This should be unique to prevent confusion.
  • Mnemonic - This is not required, but it used as a secondary identifier. This does not appear in the product and unless you have another use for it, the recommendation would be to make this the same as the code.
  • Inactive - The inactive flag allows you to inactivate or hide an entry.
  • Enforced - The enforced flag designates whether a dictionary item is required and cannot be changed. In most cases, this comes predefined by Allscripts and should not be selected for new entries. If an entry is enforced, it cannot be modified or inactivated.
  • Modifier Type- Defines whether the modifier can be used with a visit charge code, procedure charge code, or both.


Modifiers & Definitions

  • 21 - Prolonged evaluation and management services
  • 22 - Unusual procedureal services
  • 23 - Unusual anesthesia
  • 24 - Unrelated evaluation and management service by the same physician during a postoperative period
  • 25 - Significant, separately identifiable E/M svc. by the same physician on same day of the procedure or other service
  • 26 - Professional component
  • 27 - Multiple outpatient hospital E/M encounters on the same date
  • 32 - Mandated services
  • 47 - Anesthesia by surgeon
  • 50 - Bilateral procedure
  • 51 - Multiple procedures
  • 52 - Reduced services
  • 53 - Discontinued procedure (in-patient/office only)
  • 54 - Surgical care only
  • 55 - Postoperative management only
  • 56 - Preoperative management only
  • 57 - Decision for surgery
  • 58 - Staged or related procedure or service by the same physician during the postoperative period
  • 59 - Distinct procedural service
  • 62 - Two surgeons
  • 63 - Procedure performed on infants less than 4 kg.
  • 66 - Surgical team
  • 73 - Discontinued out-patient hospital/ASC procedure prior to the administration of anesthesia
  • 74 - Discontinued out-patient hospital/ASC procedure after administration of anesthesia
  • 76 - Repeat procedure by same physician
  • 77 - Repeat procedure by another physician
  • 78 - Return to the operating room for a related procedure during the postoperative period
  • 79 - Unrelated procedure or service by the same physician during the posoperative period
  • 80 - Assistant surgeon
  • 81 - Minimum assistant surgeon
  • 82 - Assistant surgeon (when qualified resident surgeon not available)
  • 90 - Reference (outside)laboratory
  • 91 - Repeat clinical diagnostic laboratory test
  • AS - Physician assistant, nurse practioner or clinical nurse specialist srevices for assistant at surgery