AMA CPT® Assistant - 2003 Issue 9 (September)
Hospital Outpatient Reporting Part IV: Use of the CPT Modifiers '52,' '58,' '59,' '73,' '74,' '76,' '77,' '78,' and '91' (September 2003)
September 2003 pages 3-10 Coding Update:Hospital Outpatient Reporting Part IV: Use of the CPT Modifiers '52,' '58,' '59,' '73,' '74,' '76,' '77,' '78,' and '91' In this segment of a multi-part series related to the Centers for Medicare and Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) we continue discussion of the CPT "reduced services modifiers" ('52'), "multiple procedure modifiers" ('58', '59,' '91'), the "discontinued procedure modifiers" ('73,' '74'), and the "repeat modifiers" ('76,' '77,' '78,' '79'), in accordance with CMS outpatient hospital reporting policy. (Refer...
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Article Overview
This premium CPT Assistant article discusses hospital outpatient reporting under CMS OPPS and compares CPT and CMS approaches to selected modifier use. It is aimed at coders, billing staff, and compliance professionals who work with outpatient hospital claims and need to understand the broad categories of guidance covered in the article, including reduced services, staged procedures, distinct services, repeat procedures, discontinued procedures, radiology-related reporting, and laboratory repeat testing. The article also references related CMS and CPT policy materials that frame how these modifiers are discussed in the outpatient setting.
Why This Topic Matters
Correct outpatient modifier reporting affects claim handling, payment processing, and compliance with CMS policy. The article helps readers understand how CMS-oriented hospital outpatient guidance is organized and why certain modifier categories require special attention.
Article Sections
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September 2003 pages 3-10
Publication information and the introductory framing for this installment of the hospital outpatient reporting series.
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Coding Update: Hospital Outpatient Reporting Part IV
Overview of the modifier categories covered in the article and the CMS outpatient hospital reporting context.
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Modifier 52
Discussion of reduced services in the hospital outpatient setting, including several broad usage categories and related CMS policy context.
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Modifier 58
Guidance on staged or related procedures during the postoperative period and how this concept is addressed in outpatient reporting.
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Modifier 59 and Modifier 91
Comparison of distinct procedural service reporting with repeat clinical diagnostic laboratory testing, including CMS and NCCI context.
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Modifiers for Discontinued Procedures
Discussion of the outpatient and ASC discontinuation modifiers and their placement in the broader CMS reporting framework.
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Frequently Posed Questions to CMS Regarding Use of Modifiers 73 and 74
A Q&A-style section summarizing CMS guidance themes related to discontinued procedures in outpatient and ASC settings.
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Modifier 73
Guidance on a discontinued outpatient hospital or ASC procedure prior to anesthesia, including the circumstances addressed by CMS policy.
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Modifier 74
Guidance on a discontinued outpatient hospital or ASC procedure after anesthesia, including the circumstances addressed by CMS policy.
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Modifiers for Repeat Procedures
Discussion of repeat procedure reporting in the hospital outpatient setting and how same-day repeat scenarios are organized.
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Modifier 76
Guidance on repeated services performed in a separate operative session by the same physician.
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Modifier 77
Guidance on repeated services performed in a separate operative session by another physician.
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Modifier 78
Discussion of return-to-operating-room reporting for a related procedure during the postoperative period.
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Modifier 79
Discussion of unrelated procedure reporting during the postoperative period in the outpatient context.
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Modifiers for Radiology Services
Broad guidance on which modifier categories are addressed for radiology reporting and how reduced-service concepts are treated in that setting.
What You Will Learn
- How CMS outpatient hospital reporting topics are organized in this installment of the series.
- Which broad modifier categories are discussed for reduced, staged, distinct, repeat, and discontinued services.
- How the article frames outpatient reporting differences across surgical, laboratory, and radiology contexts.
- How CMS and NCCI references are used to support modifier-related guidance in the article.
Who Should Read This
- Hospital outpatient coders
- Facility billing staff
- Compliance professionals
- Revenue cycle staff
- Outpatient claims specialists
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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