Admin Table of Contents
- 1 What is modifier P1 used for?
- 2 What do modifiers P1 through P6 indicate when used with anesthesia codes?
- 3 What modifier is used with anesthesia codes?
- 4 What is a KX modifier?
- 5 What do you need to know about anesthesia modifiers?
- 6 Is there reimbursement for modifiers P1-P6?
- 7 When to use P-4 in anesthesia billing?
What is modifier P1 used for?
Monitored anesthesia care
| Modifier | Description |
|---|---|
| P1 | A normal healthy patient |
| P2 | A patient with mild systemic disease |
| P3 | A patient with severe systemic disease |
| P4 | A Patient with severe systemic disease that is a constant threat to life |
What do modifiers P1 through P6 indicate when used with anesthesia codes?
Anesthesia Payment Basics Series: #4 Physical Status
| Modifier | CPT/HCPCS Descriptor |
|---|---|
| P4 | A patient with severe systemic disease that is a constant threat to life |
| P5 | A moribund patient who is not expected to survive without the operation |
| P6 | A declared brain-dead patient whose organs are being removed for donor purposes |
What does modifier P1 mean?
Definition. Modifier P1 A normal healthy patient. Modifier P2 A patient with mild systemic disease. Modifier P3 A patient with severe systemic disease. Modifier P4 A patient with severe systemic disease that is a constant threat to life.
What modifier is used with anesthesia codes?
Modifiers are two-character indicators used to modify payment of a procedure code or otherwise identify the detail on a claim. Every anesthesia procedure billed to OWCP must include one of the following anesthesia modifiers: AA, QY, QK, AD, QX or QZ.
What is a KX modifier?
The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.
What does GC modifier stand for?
A GC Modifier is a modifier added to a CPT code for service(s) performed in part by a resident under the direction of a teaching physician (TP). When should the GC modifier be used? A GC Modifier is used when a resident, under the direction of a teaching physician, is involved in the management and care of a patient.
What do you need to know about anesthesia modifiers?
A modifier is a two-position alpha or numeric code appended to a CPT code to clarify the services being billed. Modifiers provide a means by which a service can be altered without changing the procedure code. Anesthesia informational modifiers that shall be placed in the second modifier position.
Is there reimbursement for modifiers P1-P6?
Reimbursement for modifiers P1 – P6 is bundled in the payment for codes 00100-01999. This policy is sourced to OAR 410-130-0368 – Anesthesia Services, which states: “(6) Reimbursement for qualifying circumstances codes 99100-99140 and modifiers P1-P6 is bundled in the payment for codes 00100-01999.
How are physical status modifiers used in CPT?
These six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in the CPT codebook to distinguish among various levels of complexity of the anesthesia service provided. Healthy, non-smoking, no or minimal alcohol use
When to use P-4 in anesthesia billing?
P-4 Add two time units when a patient has a severe systemic disease that is a constant threat to life, such as severe respiratory or cardiac disease. Under certain circumstances, medical services and procedures may need to be further modified. Modifiers commonly used in anesthesia are :