AMA CPT® Assistant - 1997 Issue 5 (May)
Coding Clarification (May 1997)
May 1997 page 4-end Coding Clarification coding clarification Is -25 modifier ever warranted with 99211 , or is modifier -25 only appropriate on the highest level of E/M service?* Modifier -25 is intended to be appended to the appropriate level of E/M service to indicate that a significant, separately identifiable evaluation and management service was provided by the same physician on the same day of a procedure or other service. If code 99211 most accurately describes the E/M service provided, then it would be appropriate to append modifier -25 to code 99211 . This modifier is not restricted to any...
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Article Overview
This article reviews CPT coding clarification topics from a May 1997 Coding Clarification feature, with emphasis on modifier use across evaluation and management services, surgical procedures, anesthesia, bilateral services, repeat services, assistant surgeon reporting, outside laboratory work, and multiple-modifier situations. It is relevant to coders, billers, compliance staff, and physician practices that need to understand the scope of CPT modifier guidance and the kinds of scenarios discussed in the article.
Why This Topic Matters
Modifier reporting affects how services are represented on claims and how payors interpret procedures performed on the same day, during postoperative periods, or in combination with other services. Understanding the article helps readers identify which modifier topics and CPT examples are covered before consulting the full guidance.
Article Sections
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Modifier -25 and E/M Service Reporting
Discusses modifier use with evaluation and management services and clarifies its relationship to different E/M levels.
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Modifier -26, Professional Component
Covers professional-component reporting for procedures that have both physician and technical components.
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Modifier -32, Mandated Services
Addresses mandated consultations and related services in the context of third-party program requirements.
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Modifier -47, Anesthesia by Surgeon
Reviews reporting when a surgeon personally provides anesthesia associated with a surgical procedure.
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Modifier -50, Bilateral Procedure
Explains bilateral procedure reporting and discusses general situations where the modifier may be considered.
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Modifier -51, Multiple Procedures
Covers multiple-procedure reporting and discusses its relationship to other modifier concepts and add-on procedures.
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Modifier -52, Reduced Services
Addresses partially reduced or eliminated services and includes a brief discussion of how reduced-service situations are presented.
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Modifier -53, Discontinued Procedure
Explains discontinued procedures and distinguishes them from elective cancellation and related circumstances.
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Modifiers -54, -55, -56
Discusses surgical care only, postoperative management only, and preoperative management only in relation to global surgical services.
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Modifier -57, Decision for Surgery
Reviews the evaluation and management service associated with the initial decision to perform surgery.
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Modifier -58, Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Covers staged or related services performed during the postoperative period and contrasts them with other postoperative reporting concepts.
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Modifier -59, Distinct Procedural Service
Discusses distinct or independent services provided on the same date and the circumstances under which this modifier is referenced.
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Modifier -62, Two Surgeons
Reviews situations involving two surgeons and shared participation in a surgical procedure.
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Modifier -66, Surgical Team
Covers team-based surgical reporting for complex procedures involving multiple physicians and staff.
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Modifiers -76, -77, -78, -79
Addresses repeat procedures, related postoperative returns, and unrelated postoperative services.
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Modifiers -80, -81, -82
Discusses assistant surgeon reporting, including minimum assistance and resident-unavailable scenarios.
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Modifier -90, Reference (Outside) Laboratory
Covers outside laboratory reporting when testing is performed by a reference laboratory.
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Modifier -99, Multiple Modifiers
Explains how multiple modifiers may be used together to describe a single service more completely.
What You Will Learn
- How the article frames CPT modifier topics across E/M, surgery, anesthesia, and laboratory reporting
- Which modifier categories are discussed in the May 1997 Coding Clarification feature
- What kinds of general clinical and billing scenarios are used to illustrate modifier reporting
- How the article situates CPT guidance alongside third-party payor considerations
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practice managers
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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