AMA CPT® Assistant - 1997 Issue 9 (September)
More on Modifiers (September 1997)
September 1997 page 4 Coding Communication More on Modifiers Just when you thought you had heard everything there was to hear about modifiers, we bring you more information. Our May 1997 issue dedicated to modifiers generated some very interesting questions. Bilateral Procedures There continues to be some misunderstanding that CPT advocates a two-line method of reporting bilateral procedures, based on the wording of the -50 modifier description (ie, 12345,12345-50). The intent of CPT is that a single-line method be used (ie, 12345-50). It has been suggested to the CPT Editorial Panel that this description be modified to make...
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Article Overview
This article reviews selected modifier topics from a 1997 CPT Assistant issue and notes where misunderstandings commonly arose between CPT guidance and Medicare/HCFA instructions. It is useful for coders, auditors, and compliance staff who want historical context on modifier usage in general, including bilateral procedures, multiple procedures, decision-for-surgery scenarios, and postoperative return-to-OR situations.
Why This Topic Matters
Modifier usage can affect how procedures and evaluation/management services are reported, and differences between CPT and Medicare guidance can create compliance risk or claim-edit issues. This article helps readers understand the kind of modifier clarification that was being emphasized in professional coding guidance at the time.
Article Sections
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Coding Communication
Introduces the modifier topic and frames the article as a response to reader questions from a prior issue.
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Bilateral Procedures
Discusses reporting practices for bilateral services and notes that the article addresses confusion surrounding CPT’s preferred approach.
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Multiple Procedures
Covers multiple-procedure reporting and mentions a corrected modifier description along with a note about add-on codes and related coding context.
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Decision for Surgery
Compares CPT and Medicare/HCFA guidance for situations involving evaluation and management services and the decision to perform surgery.
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Return to the Operating Room (OR)
Addresses postoperative return-to-operating-room situations and contrasts closely related modifier concepts discussed in the article.
What You Will Learn
- How the article frames common questions about modifiers
- How the article distinguishes CPT guidance from Medicare/HCFA guidance
- What general areas of modifier reporting are discussed
- How historical modifier clarification was presented in a coding newsletter format
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Billing staff
- Physician practice administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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