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andrewallenbruce / northstar

Tidy Healthcare Revenue Integrity :compass:
https://andrewallenbruce.github.io/northstar/
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`modifiers()` Implementation #8

Open andrewallenbruce opened 6 months ago

andrewallenbruce commented 6 months ago

Needs to be categorized somehow

Code

``` r library(northstar) search_modifiers() |> print(n = Inf) #> # A tibble: 448 × 3 #> mod label definition #> #> 1 25 "Significant, Separately Identifiable Evaluation and Manag… It may be… #> 2 59 "Distinct Procedural Service" Under cer… #> 3 95 "Synchronous Telemedicine Service Rendered Via a Real-Time… Synchrono… #> 4 AH "Clinical Psychologist" #> 5 AJ "Clinical Social Worker" #> 6 G0 "Telehealth Services for Diagnosis, Evaluation, or Treatme… #> 7 GQ "Telehealth Service Rendered Via Asynchronous Telecommunic… #> 8 GT "Telehealth Service Rendered Via Interactive Audio and Vid… #> 9 HE "Mental Health Program" #> 10 HF "Substance Abuse Program" #> 11 HG "Opioid Addiction Treatment Program" #> 12 HH "Integrated Mental Health/Substance Abuse Program" #> 13 HI "Integrated Mental Health and Intellectual Disability/Deve… #> 14 HJ "Employee Assistance Program" #> 15 HK "Specialized Mental Health Programs for High-Risk Populati… #> 16 HQ "Group Setting" #> 17 HR "Family/Couple with Client Present" #> 18 HS "Family/Couple without Client Present" #> 19 U8 "Medicaid Level of Care 8, as Defined by Each State" #> 20 UD "Medicaid Level of Care 13, as Defined by Each State" #> 21 22 "Increased Procedural Services" When the … #> 22 23 "Unusual Anesthesia" Occasiona… #> 23 24 "Unrelated Evaluation and Management Service by the Same P… The physi… #> 24 26 "Professional Component" Certain p… #> 25 27 "Multiple Outpatient Hospital E/M Encounters on the Same D… For hospi… #> 26 32 "Mandated Services" Services … #> 27 33 "Preventive Services" When the … #> 28 47 "Anesthesia by Surgeon" Regional … #> 29 50 "Bilateral Procedure" Unless ot… #> 30 51 "Multiple Procedures" When mult… #> 31 52 "Reduced Services" Under cer… #> 32 53 "Discontinued Procedure" Under cer… #> 33 54 "Surgical Care Only" When 1 ph… #> 34 55 "Postoperative Management Only" When 1 ph… #> 35 56 "Preoperative Management Only" When 1 ph… #> 36 57 "Decision for Surgery" An evalua… #> 37 58 "Staged or Related Procedure or Service by the Same Physic… It may be… #> 38 62 "Two Surgeons" When 2 su… #> 39 63 "Procedure Performed on Infants Less Than 4 kg" Procedure… #> 40 66 "Surgical Team" Under som… #> 41 73 "Discontinued Outpatient Hospital/Ambulatory Surgery Cente… Due to ex… #> 42 74 "Discontinued Outpatient Hospital/Ambulatory Surgery Cente… Due to ex… #> 43 76 "Repeat Procedure by Same Physician or Other Qualified Hea… It may be… #> 44 77 "Repeat Procedure by Another Physician or Other Qualified … It may be… #> 45 78 "Unplanned Return to the Operating/Procedure Room by the S… It may be… #> 46 79 "Unrelated Procedure or Service by the Same Physician or O… The indiv… #> 47 80 "Assistant Surgeon" Surgical … #> 48 81 "Minimum Assistant Surgeon" Minimum s… #> 49 82 "Assistant Surgeon (when qualified resident surgeon not av… The unava… #> 50 90 "Reference (Outside) Laboratory" When labo… #> 51 91 "Repeat Clinical Diagnostic Laboratory Test" In the co… #> 52 92 "Alternative Laboratory Platform Testing" When labo… #> 53 93 "Synchronous Telemedicine Service Rendered Via Telephone o… Synchrono… #> 54 96 "Habilitative Services" When a se… #> 55 97 "Rehabilitative Services" When a se… #> 56 99 "Multiple Modifiers" Under cer… #> 57 P1 "A normal healthy patient" The Physi… #> 58 P2 "A patient with mild systemic disease" The Physi… #> 59 P3 "A patient with severe systemic disease" The Physi… #> 60 P4 "A patient with severe systemic disease that is a constant… The Physi… #> 61 P5 "A moribund patient who is not expected to survive without… The Physi… #> 62 P6 "A declared brain-dead patient whose organs are being remo… The Physi… #> 63 1P "Performance Measure Exclusion Modifier due to Medical Rea… Reasons i… #> 64 2P "Performance Measure Exclusion Modifier due to Patient Rea… Reasons i… #> 65 3P "Performance Measure Exclusion Modifier due to System Reas… Reasons i… #> 66 8P "Performance Measure Reporting Modifier, action not perfor… Modifier … #> 67 E1 "Upper left, eyelid" #> 68 E2 "Lower left, eyelid" #> 69 E3 "Upper right, eyelid" #> 70 E4 "Lower right, eyelid" #> 71 F1 "Left hand, second digit" #> 72 F2 "Left hand, third digit" #> 73 F3 "Left hand, fourth digit" #> 74 F4 "Left hand, fifth digit" #> 75 F5 "Right hand, thumb" #> 76 F6 "Right hand, second digit" #> 77 F7 "Right hand, third digit" #> 78 F8 "Right hand, fourth digit" #> 79 F9 "Right hand, fifth digit" #> 80 FA "Left hand, thumb" #> 81 GG "Performance and payment of a screening mammogram and diag… #> 82 GH "Diagnostic mammogram converted to screening mammogram on … #> 83 LC "Left circumflex coronary artery" #> 84 LD "Left anterior descending coronary artery" #> 85 LM "Left main coronary artery" #> 86 LT "Left side (used to identify procedures performed on the l… #> 87 QM "Ambulance service provided under arrangement by a provide… #> 88 QN "Ambulance service furnished directly by a provider of ser… #> 89 RC "Right coronary artery" #> 90 RT "Right side (used to identify procedures performed on the … #> 91 T1 "Left foot, second digit" #> 92 T2 "Left foot, third digit" #> 93 T3 "Left foot, fourth digit" #> 94 T4 "Left foot, fifth digit" #> 95 T5 "Right foot, great toe" #> 96 T6 "Right foot, second digit" #> 97 T7 "Right foot, third digit" #> 98 T8 "Right foot, fourth digit" #> 99 T9 "Right foot, fifth digit" #> 100 TA "Left foot, great toe" #> 101 XE "Separate Encounter, A Service That Is Distinct Because It… #> 102 XP "Separate Practitioner, A Service That Is Distinct Because… #> 103 XS "Separate Structure, A Service That Is Distinct Because It… #> 104 XU "Unusual Non-Overlapping Service, The Use Of A Service Tha… #> 105 A1 "Dressing for one wound" #> 106 A2 "Dressing for two wounds" #> 107 A3 "Dressing for three wounds" #> 108 A4 "Dressing for four wounds" #> 109 A5 "Dressing for five wounds" #> 110 A6 "Dressing for six wounds" #> 111 A7 "Dressing for seven wounds" #> 112 A8 "Dressing for eight wounds" #> 113 A9 "Dressing for nine or more wounds" #> 114 AA "Anesthesia services performed personally by anesthesiolog… #> 115 AB "Audiology service furnished personally by an audiologist … #> 116 AD "Medical supervision by a physician: more than four concur… #> 117 AE "Registered dietician" #> 118 AF "Specialty physician" #> 119 AG "Primary physician" #> 120 AH "Clinical psychologist" #> 121 AI "Principal physician of record" #> 122 AJ "Clinical social worker" #> 123 AK "Non participating physician" #> 124 AM "Physician, team member service" #> 125 AO "Alternate payment method declined by provider of service" #> 126 AP "Determination of refractive state was not performed in th… #> 127 AQ "Physician providing a service in an unlisted health profe… #> 128 AR "Physician provider services in a physician scarcity area" #> 129 AS "Physician assistant, nurse practitioner, or clinical nurs… #> 130 AT "Acute treatment (this modifier should be used when report… #> 131 AU "Item furnished in conjunction with a urological, ostomy, … #> 132 AV "Item furnished in conjunction with a prosthetic device, p… #> 133 AW "Item furnished in conjunction with a surgical dressing" #> 134 AX "Item furnished in conjunction with dialysis services" #> 135 AY "Item or service furnished to an esrd patient that is not … #> 136 AZ "Physician providing a service in a dental health professi… #> 137 BA "Item furnished in conjunction with parenteral enteral nut… #> 138 BL "Special acquisition of blood and blood products" #> 139 BO "Orally administered nutrition, not by feeding tube" #> 140 BP "The beneficiary has been informed of the purchase and ren… #> 141 BR "The beneficiary has been informed of the purchase and ren… #> 142 BU "The beneficiary has been informed of the purchase and ren… #> 143 CA "Procedure payable only in the inpatient setting when perf… #> 144 CB "Service ordered by a renal dialysis facility (rdf) physic… #> 145 CC "Procedure code change (use 'cc' when the procedure code s… #> 146 CD "Amcc test has been ordered by an esrd facility or mcp phy… #> 147 CE "Amcc test has been ordered by an esrd facility or mcp phy… #> 148 CF "Amcc test has been ordered by an esrd facility or mcp phy… #> 149 CG "Policy criteria applied" #> 150 CH "0 percent impaired, limited or restricted" #> 151 CI "At least 1 percent but less than 20 percent impaired, lim… #> 152 CJ "At least 20 percent but less than 40 percent impaired, li… #> 153 CK "At least 40 percent but less than 60 percent impaired, li… #> 154 CL "At least 60 percent but less than 80 percent impaired, li… #> 155 CM "At least 80 percent but less than 100 percent impaired, l… #> 156 CN "100 percent impaired, limited or restricted" #> 157 CO "Outpatient occupational therapy services furnished in who… #> 158 CP "Adjunctive service related to a procedure assigned to a c… #> 159 CQ "Outpatient physical therapy services furnished in whole o… #> 160 CR "Catastrophe/disaster related" #> 161 CS "Cost-sharing waived for specified covid-19 testing-relate… #> 162 CT "Computed tomography services furnished using equipment th… #> 163 DA "Oral health assessment by a licensed health professional … #> 164 EA "Erythropoetic stimulating agent (esa) administered to tre… #> 165 EB "Erythropoetic stimulating agent (esa) administered to tre… #> 166 EC "Erythropoetic stimulating agent (esa) administered to tre… #> 167 ED "Hematocrit level has exceeded 39% (or hemoglobin level ha… #> 168 EE "Hematocrit level has not exceeded 39% (or hemoglobin leve… #> 169 EJ "Subsequent claims for a defined course of therapy, e.g., … #> 170 EM "Emergency reserve supply (for esrd benefit only)" #> 171 EP "Service provided as part of medicaid early periodic scree… #> 172 ER "Items and services furnished by a provider-based, off-cam… #> 173 ET "Emergency services" #> 174 EX "Expatriate beneficiary" #> 175 EY "No physician or other licensed health care provider order… #> 176 FB "Item provided without cost to provider, supplier or pract… #> 177 FC "Partial credit received for replaced device" #> 178 FP "Service provided as part of family planning program" #> 179 FQ "The service was furnished using audio-only communication … #> 180 FR "The supervising practitioner was present through two-way,… #> 181 FS "Split (or shared) evaluation and management visit" #> 182 FT "Unrelated evaluation and management (e/m) visit on the sa… #> 183 FX "X-ray taken using film" #> 184 FY "X-ray taken using computed radiography technology/cassett… #> 185 G0 "Telehealth services for diagnosis, evaluation, or treatme… #> 186 G1 "Most recent urr reading of less than 60" #> 187 G2 "Most recent urr reading of 60 to 64.9" #> 188 G3 "Most recent urr reading of 65 to 69.9" #> 189 G4 "Most recent urr reading of 70 to 74.9" #> 190 G5 "Most recent urr reading of 75 or greater" #> 191 G6 "Esrd patient for whom less than six dialysis sessions hav… #> 192 G7 "Pregnancy resulted from rape or incest or pregnancy certi… #> 193 G8 "Monitored anesthesia care (mac) for deep complex, complic… #> 194 G9 "Monitored anesthesia care for patient who has history of … #> 195 GA "Waiver of liability statement issued as required by payer… #> 196 GB "Claim being re-submitted for payment because it is no lon… #> 197 GC "This service has been performed in part by a resident und… #> 198 GD "Units of service exceeds medically unlikely edit value an… #> 199 GE "This service has been performed by a resident without the… #> 200 GF "Non-physician (e.g. nurse practitioner (np), certified re… #> 201 GH "Diagnostic mammogram converted from screening mammogram o… #> 202 GJ "\"opt out\" physician or practitioner emergency or urgent… #> 203 GK "Reasonable and necessary item/service associated with a g… #> 204 GL "Medically unnecessary upgrade provided instead of non-upg… #> 205 GM "Multiple patients on one ambulance trip" #> 206 GN "Services delivered under an outpatient speech language pa… #> 207 GO "Services delivered under an outpatient occupational thera… #> 208 GP "Services delivered under an outpatient physical therapy p… #> 209 GQ "Via asynchronous telecommunications system" #> 210 GR "This service was performed in whole or in part by a resid… #> 211 GS "Dosage of erythropoietin stimulating agent has been reduc… #> 212 GT "Via interactive audio and video telecommunication systems" #> 213 GU "Waiver of liability statement issued as required by payer… #> 214 GV "Attending physician not employed or paid under arrangemen… #> 215 GW "Service not related to the hospice patient's terminal con… #> 216 GX "Notice of liability issued, voluntary under payer policy" #> 217 GY "Item or service statutorily excluded, does not meet the d… #> 218 GZ "Item or service expected to be denied as not reasonable a… #> 219 H9 "Court-ordered" #> 220 HA "Child/adolescent program" #> 221 HB "Adult program, non geriatric" #> 222 HC "Adult program, geriatric" #> 223 HD "Pregnant/parenting women's program" #> 224 HE "Mental health program" #> 225 HF "Substance abuse program" #> 226 HG "Opioid addiction treatment program" #> 227 HH "Integrated mental health/substance abuse program" #> 228 HI "Integrated mental health and intellectual disability/deve… #> 229 HJ "Employee assistance program" #> 230 HK "Specialized mental health programs for high-risk populati… #> 231 HL "Intern" #> 232 HM "Less than bachelor degree level" #> 233 HN "Bachelors degree level" #> 234 HO "Masters degree level" #> 235 HP "Doctoral level" #> 236 HQ "Group setting" #> 237 HR "Family/couple with client present" #> 238 HS "Family/couple without client present" #> 239 HT "Multi-disciplinary team" #> 240 HU "Funded by child welfare agency" #> 241 HV "Funded state addictions agency" #> 242 HW "Funded by state mental health agency" #> 243 HX "Funded by county/local agency" #> 244 HY "Funded by juvenile justice agency" #> 245 HZ "Funded by criminal justice agency" #> 246 J1 "Competitive acquisition program no-pay submission for a p… #> 247 J2 "Competitive acquisition program, restocking of emergency … #> 248 J3 "Competitive acquisition program (cap), drug not available… #> 249 J4 "Dmepos item subject to dmepos competitive bidding program… #> 250 J5 "Off-the-shelf orthotic subject to dmepos competitive bidd… #> 251 JA "Administered intravenously" #> 252 JB "Administered subcutaneously" #> 253 JC "Skin substitute used as a graft" #> 254 JD "Skin substitute not used as a graft" #> 255 JE "Administered via dialysate" #> 256 JF "Compounded drug" #> 257 JG "Drug or biological acquired with 340b drug pricing progra… #> 258 JK "One month supply or less of drug or biological" #> 259 JL "Three month supply of drug or biological" #> 260 JW "Drug amount discarded/not administered to any patient" #> 261 JZ "Zero drug amount discarded/not administered to any patien… #> 262 K0 "Lower extremity prosthesis functional level 0 - does not … #> 263 K1 "Lower extremity prosthesis functional level 1 - has the a… #> 264 K2 "Lower extremity prosthesis functional level 2 - has the a… #> 265 K3 "Lower extremity prosthesis functional level 3 - has the a… #> 266 K4 "Lower extremity prosthesis functional level 4 - has the a… #> 267 KA "Add on option/accessory for wheelchair" #> 268 KB "Beneficiary requested upgrade for abn, more than 4 modifi… #> 269 KC "Replacement of special power wheelchair interface" #> 270 KD "Drug or biological infused through dme" #> 271 KE "Bid under round one of the dmepos competitive bidding pro… #> 272 KF "Item designated by fda as class iii device" #> 273 KG "Dmepos item subject to dmepos competitive bidding program… #> 274 KH "Dmepos item, initial claim, purchase or first month renta… #> 275 KI "Dmepos item, second or third month rental" #> 276 KJ "Dmepos item, parenteral enteral nutrition (pen) pump or c… #> 277 KK "Dmepos item subject to dmepos competitive bidding program… #> 278 KL "Dmepos item delivered via mail" #> 279 KM "Replacement of facial prosthesis including new impression… #> 280 KN "Replacement of facial prosthesis using previous master mo… #> 281 KO "Single drug unit dose formulation" #> 282 KP "First drug of a multiple drug unit dose formulation" #> 283 KQ "Second or subsequent drug of a multiple drug unit dose fo… #> 284 KR "Rental item, billing for partial month" #> 285 KS "Glucose monitor supply for diabetic beneficiary not treat… #> 286 KT "Beneficiary resides in a competitive bidding area and tra… #> 287 KU "Dmepos item subject to dmepos competitive bidding program… #> 288 KV "Dmepos item subject to dmepos competitive bidding program… #> 289 KW "Dmepos item subject to dmepos competitive bidding program… #> 290 KX "Requirements specified in the medical policy have been me… #> 291 KY "Dmepos item subject to dmepos competitive bidding program… #> 292 KZ "New coverage not implemented by managed care" #> 293 L1 "Provider attestation that the hospital laboratory test(s)… #> 294 LL "Lease/rental (use the 'll' modifier when dme equipment re… #> 295 LR "Laboratory round trip" #> 296 LS "Fda-monitored intraocular lens implant" #> 297 LU "Fractionated payment" #> 298 M2 "Medicare secondary payer (msp)" #> 299 MA "Ordering professional is not required to consult a clinic… #> 300 MB "Ordering professional is not required to consult a clinic… #> 301 MC "Ordering professional is not required to consult a clinic… #> 302 MD "Ordering professional is not required to consult a clinic… #> 303 ME "The order for this service adheres to appropriate use cri… #> 304 MF "The order for this service does not adhere to the appropr… #> 305 MG "The order for this service does not have applicable appro… #> 306 MH "Unknown if ordering professional consulted a clinical dec… #> 307 MS "Six month maintenance and servicing fee for reasonable an… #> 308 N1 "Group 1 oxygen coverage criteria met" #> 309 N2 "Group 2 oxygen coverage criteria met" #> 310 N3 "Group 3 oxygen coverage criteria met" #> 311 NB "Nebulizer system, any type, fda-cleared for use with spec… #> 312 NR "New when rented (use the 'nr' modifier when dme which was… #> 313 NU "New equipment" #> 314 PA "Surgical or other invasive procedure on wrong body part" #> 315 PB "Surgical or other invasive procedure on wrong patient" #> 316 PC "Wrong surgery or other invasive procedure on patient" #> 317 PD "Diagnostic or related non diagnostic item or service prov… #> 318 PI "Positron emission tomography (pet) or pet/computed tomogr… #> 319 PL "Progressive addition lenses" #> 320 PM "Post mortem" #> 321 PN "Non-excepted service provided at an off-campus, outpatien… #> 322 PO "Excepted service provided at an off-campus, outpatient, p… #> 323 PS "Positron emission tomography (pet) or pet/computed tomogr… #> 324 PT "Colorectal cancer screening test; converted to diagnostic… #> 325 Q0 "Investigational clinical service provided in a clinical r… #> 326 Q1 "Routine clinical service provided in a clinical research … #> 327 Q2 "Demonstration procedure/service" #> 328 Q3 "Live kidney donor surgery and related services" #> 329 Q4 "Service for ordering/referring physician qualifies as a s… #> 330 Q5 "Service furnished under a reciprocal billing arrangement … #> 331 Q6 "Service furnished under a fee-for-time compensation arran… #> 332 Q7 "One class a finding" #> 333 Q8 "Two class b findings" #> 334 Q9 "One class b and two class c findings" #> 335 QA "Prescribed amounts of stationary oxygen for daytime use w… #> 336 QB "Prescribed amounts of stationary oxygen for daytime use w… #> 337 QC "Single channel monitoring" #> 338 QD "Recording and storage in solid state memory by a digital … #> 339 QE "Prescribed amount of stationary oxygen while at rest is l… #> 340 QF "Prescribed amount of stationary oxygen while at rest exce… #> 341 QG "Prescribed amount of stationary oxygen while at rest is g… #> 342 QH "Oxygen conserving device is being used with an oxygen del… #> 343 QJ "Services/items provided to a prisoner or patient in state… #> 344 QK "Medical direction of two, three, or four concurrent anest… #> 345 QL "Patient pronounced dead after ambulance called" #> 346 QP "Documentation is on file showing that the laboratory test… #> 347 QQ "Ordering professional consulted a qualified clinical deci… #> 348 QR "Prescribed amounts of stationary oxygen for daytime use w… #> 349 QS "Monitored anesthesia care service" #> 350 QT "Recording and storage on tape by an analog tape recorder" #> 351 QW "Clia waived test" #> 352 QX "Crna service: with medical direction by a physician" #> 353 QY "Medical direction of one certified registered nurse anest… #> 354 QZ "Crna service: without medical direction by a physician" #> 355 RA "Replacement of a dme, orthotic or prosthetic item" #> 356 RB "Replacement of a part of a dme, orthotic or prosthetic it… #> 357 RD "Drug provided to beneficiary, but not administered \"inci… #> 358 RE "Furnished in full compliance with fda-mandated risk evalu… #> 359 RI "Ramus intermedius coronary artery" #> 360 RR "Rental (use the 'rr' modifier when dme is to be rented)" #> 361 SA "Nurse practitioner rendering service in collaboration wit… #> 362 SB "Nurse midwife" #> 363 SC "Medically necessary service or supply" #> 364 SD "Services provided by registered nurse with specialized, h… #> 365 SE "State and/or federally-funded programs/services" #> 366 SF "Second opinion ordered by a professional review organizat… #> 367 SG "Ambulatory surgical center (asc) facility service" #> 368 SH "Second concurrently administered infusion therapy" #> 369 SJ "Third or more concurrently administered infusion therapy" #> 370 SK "Member of high risk population (use only with codes for i… #> 371 SL "State supplied vaccine" #> 372 SM "Second surgical opinion" #> 373 SN "Third surgical opinion" #> 374 SQ "Item ordered by home health" #> 375 SS "Home infusion services provided in the infusion suite of … #> 376 ST "Related to trauma or injury" #> 377 SU "Procedure performed in physician's office (to denote use … #> 378 SV "Pharmaceuticals delivered to patient's home but not utili… #> 379 SW "Services provided by a certified diabetic educator" #> 380 SY "Persons who are in close contact with member of high-risk… #> 381 SZ "Habilitative services" #> 382 TB "Drug or biological acquired with 340b drug pricing progra… #> 383 TC "Technical component; under certain circumstances, a charg… #> 384 TD "Rn" #> 385 TE "Lpn/lvn" #> 386 TF "Intermediate level of care" #> 387 TG "Complex/high tech level of care" #> 388 TH "Obstetrical treatment/services, prenatal or postpartum" #> 389 TJ "Program group, child and/or adolescent" #> 390 TK "Extra patient or passenger, non-ambulance" #> 391 TL "Early intervention/individualized family service plan (if… #> 392 TM "Individualized education program (iep)" #> 393 TN "Rural/outside providers' customary service area" #> 394 TP "Medical transport, unloaded vehicle" #> 395 TQ "Basic life support transport by a volunteer ambulance pro… #> 396 TR "School-based individualized education program (iep) servi… #> 397 TS "Follow-up service" #> 398 TT "Individualized service provided to more than one patient … #> 399 TU "Special payment rate, overtime" #> 400 TV "Special payment rates, holidays/weekends" #> 401 TW "Back-up equipment" #> 402 U1 "Medicaid level of care 1, as defined by each state" #> 403 U2 "Medicaid level of care 2, as defined by each state" #> 404 U3 "Medicaid level of care 3, as defined by each state" #> 405 U4 "Medicaid level of care 4, as defined by each state" #> 406 U5 "Medicaid level of care 5, as defined by each state" #> 407 U6 "Medicaid level of care 6, as defined by each state" #> 408 U7 "Medicaid level of care 7, as defined by each state" #> 409 U8 "Medicaid level of care 8, as defined by each state" #> 410 U9 "Medicaid level of care 9, as defined by each state" #> 411 UA "Medicaid level of care 10, as defined by each state" #> 412 UB "Medicaid level of care 11, as defined by each state" #> 413 UC "Medicaid level of care 12, as defined by each state" #> 414 UD "Medicaid level of care 13, as defined by each state" #> 415 UE "Used durable medical equipment" #> 416 UF "Services provided in the morning" #> 417 UG "Services provided in the afternoon" #> 418 UH "Services provided in the evening" #> 419 UJ "Services provided at night" #> 420 UK "Services provided on behalf of the client to someone othe… #> 421 UN "Two patients served" #> 422 UP "Three patients served" #> 423 UQ "Four patients served" #> 424 UR "Five patients served" #> 425 US "Six or more patients served" #> 426 V1 "Demonstration modifier 1" #> 427 V2 "Demonstration modifier 2" #> 428 V3 "Demonstration modifier 3" #> 429 V4 "Demonstration modifier 4" #> 430 V5 "Vascular catheter (alone or with any other vascular acces… #> 431 V6 "Arteriovenous graft (or other vascular access not includi… #> 432 V7 "Arteriovenous fistula only (in use with two needles)" #> 433 V8 "Infection present" #> 434 V9 "No infection present" #> 435 VM "Medicare diabetes prevention program (mdpp) virtual make-… #> 436 VP "Aphakic patient" #> 437 X1 "Continuous/broad services: for reporting services by clin… #> 438 X2 "Continuous/focused services: for reporting services by cl… #> 439 X3 "Episodic/broad servies: for reporting services by clinici… #> 440 X4 "Episodic/focused services: for reporting services by clin… #> 441 X5 "Diagnostic services requested by another clinician: for r… #> 442 XE "Separate encounter, a service that is distinct because it… #> 443 XP "Separate practitioner, a service that is distinct because… #> 444 XS "Separate structure, a service that is distinct because it… #> 445 XU "Unusual non-overlapping service, the use of a service tha… #> 446 ZA "Novartis/sandoz" #> 447 ZB "Pfizer/hospira" #> 448 ZC "Merck/samsung bioepis" ```

Created on 2024-03-26 with reprex v2.1.0

andrewallenbruce commented 6 months ago

See #4 for NCCI-related modifiers.

andrewallenbruce commented 3 months ago

Better output

Code

``` r library(northstar) search_modifiers() |> print(n = Inf) #> # A tibble: 432 × 4 #> modifier modifier_type modifier_description modifier_information #> #> 1 22 CPT Increased Procedural Serv… When the work requi… #> 2 23 CPT Unusual Anesthesia Occasionally, a pro… #> 3 24 CPT Unrelated Evaluation and … The physician or ot… #> 4 25 CPT Significant, Separately I… It may be necessary… #> 5 26 CPT Professional Component Certain procedures … #> 6 27 CPT Multiple Outpatient Hospi… For hospital outpat… #> 7 32 CPT Mandated Services Services related to… #> 8 33 CPT Preventive Services When the primary pu… #> 9 47 CPT Anesthesia by Surgeon Regional or general… #> 10 50 CPT Bilateral Procedure Unless otherwise id… #> 11 51 CPT Multiple Procedures When multiple proce… #> 12 52 CPT Reduced Services Under certain circu… #> 13 53 CPT Discontinued Procedure Under certain circu… #> 14 54 CPT Surgical Care Only When 1 physician or… #> 15 55 CPT Postoperative Management … When 1 physician or… #> 16 56 CPT Preoperative Management O… When 1 physician or… #> 17 57 CPT Decision for Surgery An evaluation and m… #> 18 58 CPT Staged or Related Procedu… It may be necessary… #> 19 59 CPT Distinct Procedural Servi… Under certain circu… #> 20 62 CPT Two Surgeons When 2 surgeons wor… #> 21 63 CPT Procedure Performed on In… Procedures performe… #> 22 66 CPT Surgical Team Under some circumst… #> 23 73 CPT Discontinued Outpatient H… Due to extenuating … #> 24 74 CPT Discontinued Outpatient H… Due to extenuating … #> 25 76 CPT Repeat Procedure by Same … It may be necessary… #> 26 77 CPT Repeat Procedure by Anoth… It may be necessary… #> 27 78 CPT Unplanned Return to the O… It may be necessary… #> 28 79 CPT Unrelated Procedure or Se… The individual may … #> 29 80 CPT Assistant Surgeon Surgical assistant … #> 30 81 CPT Minimum Assistant Surgeon Minimum surgical as… #> 31 82 CPT Assistant Surgeon (when q… The unavailability … #> 32 90 CPT Reference (Outside) Labor… When laboratory pro… #> 33 91 CPT Repeat Clinical Diagnosti… In the course of tr… #> 34 92 CPT Alternative Laboratory Pl… When laboratory tes… #> 35 93 CPT Synchronous Telemedicine … Synchronous telemed… #> 36 95 CPT Synchronous Telemedicine … Synchronous telemed… #> 37 96 CPT Habilitative Services When a service or p… #> 38 97 CPT Rehabilitative Services When a service or p… #> 39 99 CPT Multiple Modifiers Under certain circu… #> 40 A1 HCPCS Dressing for one wound #> 41 A2 HCPCS Dressing for two wounds #> 42 A3 HCPCS Dressing for three wounds #> 43 A4 HCPCS Dressing for four wounds #> 44 A5 HCPCS Dressing for five wounds #> 45 A6 HCPCS Dressing for six wounds #> 46 A7 HCPCS Dressing for seven wounds #> 47 A8 HCPCS Dressing for eight wounds #> 48 A9 HCPCS Dressing for nine or more… #> 49 AA HCPCS Anesthesia services perfo… #> 50 AB HCPCS Audiology service furnish… #> 51 AD HCPCS Medical supervision by a … #> 52 AE HCPCS Registered dietician #> 53 AF HCPCS Specialty physician #> 54 AG HCPCS Primary physician #> 55 AH HCPCS Clinical psychologist #> 56 AI HCPCS Principal physician of re… #> 57 AJ HCPCS Clinical social worker #> 58 AK HCPCS Non participating physici… #> 59 AM HCPCS Physician, team member se… #> 60 AO HCPCS Alternate payment method … #> 61 AP HCPCS Determination of refracti… #> 62 AQ HCPCS Physician providing a ser… #> 63 AR HCPCS Physician provider servic… #> 64 AS HCPCS Physician assistant, nurs… #> 65 AT HCPCS Acute treatment (this mod… #> 66 AU HCPCS Item furnished in conjunc… #> 67 AV HCPCS Item furnished in conjunc… #> 68 AW HCPCS Item furnished in conjunc… #> 69 AX HCPCS Item furnished in conjunc… #> 70 AY HCPCS Item or service furnished… #> 71 AZ HCPCS Physician providing a ser… #> 72 BA HCPCS Item furnished in conjunc… #> 73 BL HCPCS Special acquisition of bl… #> 74 BO HCPCS Orally administered nutri… #> 75 BP HCPCS The beneficiary has been … #> 76 BR HCPCS The beneficiary has been … #> 77 BU HCPCS The beneficiary has been … #> 78 CA HCPCS Procedure payable only in… #> 79 CB HCPCS Service ordered by a rena… #> 80 CC HCPCS Procedure code change (us… #> 81 CD HCPCS Amcc test has been ordere… #> 82 CE HCPCS Amcc test has been ordere… #> 83 CF HCPCS Amcc test has been ordere… #> 84 CG HCPCS Policy criteria applied #> 85 CH HCPCS 0 percent impaired, limit… #> 86 CI HCPCS At least 1 percent but le… #> 87 CJ HCPCS At least 20 percent but l… #> 88 CK HCPCS At least 40 percent but l… #> 89 CL HCPCS At least 60 percent but l… #> 90 CM HCPCS At least 80 percent but l… #> 91 CN HCPCS 100 percent impaired, lim… #> 92 CO HCPCS Outpatient occupational t… #> 93 CP HCPCS Adjunctive service relate… #> 94 CQ HCPCS Outpatient physical thera… #> 95 CR HCPCS Catastrophe/disaster rela… #> 96 CS HCPCS Cost-sharing waived for s… #> 97 CT HCPCS Computed tomography servi… #> 98 DA HCPCS Oral health assessment by… #> 99 E1 HCPCS Upper left, eyelid #> 100 E2 HCPCS Lower left, eyelid #> 101 E3 HCPCS Upper right, eyelid #> 102 E4 HCPCS Lower right, eyelid #> 103 EA HCPCS Erythropoetic stimulating… #> 104 EB HCPCS Erythropoetic stimulating… #> 105 EC HCPCS Erythropoetic stimulating… #> 106 ED HCPCS Hematocrit level has exce… #> 107 EE HCPCS Hematocrit level has not … #> 108 EJ HCPCS Subsequent claims for a d… #> 109 EM HCPCS Emergency reserve supply … #> 110 EP HCPCS Service provided as part … #> 111 ER HCPCS Items and services furnis… #> 112 ET HCPCS Emergency services #> 113 EX HCPCS Expatriate beneficiary #> 114 EY HCPCS No physician or other lic… #> 115 F1 HCPCS Left hand, second digit #> 116 F2 HCPCS Left hand, third digit #> 117 F3 HCPCS Left hand, fourth digit #> 118 F4 HCPCS Left hand, fifth digit #> 119 F5 HCPCS Right hand, thumb #> 120 F6 HCPCS Right hand, second digit #> 121 F7 HCPCS Right hand, third digit #> 122 F8 HCPCS Right hand, fourth digit #> 123 F9 HCPCS Right hand, fifth digit #> 124 FA HCPCS Left hand, thumb #> 125 FB HCPCS Item provided without cos… #> 126 FC HCPCS Partial credit received f… #> 127 FP HCPCS Service provided as part … #> 128 FQ HCPCS The service was furnished… #> 129 FR HCPCS The supervising practitio… #> 130 FS HCPCS Split (or shared) evaluat… #> 131 FT HCPCS Unrelated evaluation and … #> 132 FX HCPCS X-ray taken using film #> 133 FY HCPCS X-ray taken using compute… #> 134 G0 HCPCS Telehealth services for d… #> 135 G1 HCPCS Most recent urr reading o… #> 136 G2 HCPCS Most recent urr reading o… #> 137 G3 HCPCS Most recent urr reading o… #> 138 G4 HCPCS Most recent urr reading o… #> 139 G5 HCPCS Most recent urr reading o… #> 140 G6 HCPCS Esrd patient for whom les… #> 141 G7 HCPCS Pregnancy resulted from r… #> 142 G8 HCPCS Monitored anesthesia care… #> 143 G9 HCPCS Monitored anesthesia care… #> 144 GA HCPCS Waiver of liability state… #> 145 GB HCPCS Claim being re-submitted … #> 146 GC HCPCS This service has been per… #> 147 GD HCPCS Units of service exceeds … #> 148 GE HCPCS This service has been per… #> 149 GF HCPCS Non-physician (e.g. nurse… #> 150 GG HCPCS Performance and payment o… #> 151 GH HCPCS Diagnostic mammogram conv… #> 152 GJ HCPCS opt out physician or prac… #> 153 GK HCPCS Reasonable and necessary … #> 154 GL HCPCS Medically unnecessary upg… #> 155 GM HCPCS Multiple patients on one … #> 156 GN HCPCS Services delivered under … #> 157 GO HCPCS Services delivered under … #> 158 GP HCPCS Services delivered under … #> 159 GQ HCPCS Via asynchronous telecomm… #> 160 GR HCPCS This service was performe… #> 161 GS HCPCS Dosage of erythropoietin … #> 162 GT HCPCS Via interactive audio and… #> 163 GU HCPCS Waiver of liability state… #> 164 GV HCPCS Attending physician not e… #> 165 GW HCPCS Service not related to th… #> 166 GX HCPCS Notice of liability issue… #> 167 GY HCPCS Item or service statutori… #> 168 GZ HCPCS Item or service expected … #> 169 H9 HCPCS Court-ordered #> 170 HA HCPCS Child/adolescent program #> 171 HB HCPCS Adult program, non geriat… #> 172 HC HCPCS Adult program, geriatric #> 173 HD HCPCS Pregnant/parenting women'… #> 174 HE HCPCS Mental health program #> 175 HF HCPCS Substance abuse program #> 176 HG HCPCS Opioid addiction treatmen… #> 177 HH HCPCS Integrated mental health/… #> 178 HI HCPCS Integrated mental health … #> 179 HJ HCPCS Employee assistance progr… #> 180 HK HCPCS Specialized mental health… #> 181 HL HCPCS Intern #> 182 HM HCPCS Less than bachelor degree… #> 183 HN HCPCS Bachelors degree level #> 184 HO HCPCS Masters degree level #> 185 HP HCPCS Doctoral level #> 186 HQ HCPCS Group setting #> 187 HR HCPCS Family/couple with client… #> 188 HS HCPCS Family/couple without cli… #> 189 HT HCPCS Multi-disciplinary team #> 190 HU HCPCS Funded by child welfare a… #> 191 HV HCPCS Funded state addictions a… #> 192 HW HCPCS Funded by state mental he… #> 193 HX HCPCS Funded by county/local ag… #> 194 HY HCPCS Funded by juvenile justic… #> 195 HZ HCPCS Funded by criminal justic… #> 196 J1 HCPCS Competitive acquisition p… #> 197 J2 HCPCS Competitive acquisition p… #> 198 J3 HCPCS Competitive acquisition p… #> 199 J4 HCPCS Dmepos item subject to dm… #> 200 J5 HCPCS Off-the-shelf orthotic su… #> 201 JA HCPCS Administered intravenously #> 202 JB HCPCS Administered subcutaneous… #> 203 JC HCPCS Skin substitute used as a… #> 204 JD HCPCS Skin substitute not used … #> 205 JE HCPCS Administered via dialysate #> 206 JF HCPCS Compounded drug #> 207 JG HCPCS Drug or biological acquir… #> 208 JK HCPCS One month supply or less … #> 209 JL HCPCS Three month supply of dru… #> 210 JW HCPCS Drug amount discarded/not… #> 211 JZ HCPCS Zero drug amount discarde… #> 212 K0 HCPCS Lower extremity prosthesi… #> 213 K1 HCPCS Lower extremity prosthesi… #> 214 K2 HCPCS Lower extremity prosthesi… #> 215 K3 HCPCS Lower extremity prosthesi… #> 216 K4 HCPCS Lower extremity prosthesi… #> 217 KA HCPCS Add on option/accessory f… #> 218 KB HCPCS Beneficiary requested upg… #> 219 KC HCPCS Replacement of special po… #> 220 KD HCPCS Drug or biological infuse… #> 221 KE HCPCS Bid under round one of th… #> 222 KF HCPCS Item designated by fda as… #> 223 KG HCPCS Dmepos item subject to dm… #> 224 KH HCPCS Dmepos item, initial clai… #> 225 KI HCPCS Dmepos item, second or th… #> 226 KJ HCPCS Dmepos item, parenteral e… #> 227 KK HCPCS Dmepos item subject to dm… #> 228 KL HCPCS Dmepos item delivered via… #> 229 KM HCPCS Replacement of facial pro… #> 230 KN HCPCS Replacement of facial pro… #> 231 KO HCPCS Single drug unit dose for… #> 232 KP HCPCS First drug of a multiple … #> 233 KQ HCPCS Second or subsequent drug… #> 234 KR HCPCS Rental item, billing for … #> 235 KS HCPCS Glucose monitor supply fo… #> 236 KT HCPCS Beneficiary resides in a … #> 237 KU HCPCS Dmepos item subject to dm… #> 238 KV HCPCS Dmepos item subject to dm… #> 239 KW HCPCS Dmepos item subject to dm… #> 240 KX HCPCS Requirements specified in… #> 241 KY HCPCS Dmepos item subject to dm… #> 242 KZ HCPCS New coverage not implemen… #> 243 L1 HCPCS Provider attestation that… #> 244 LC HCPCS Left circumflex coronary … #> 245 LD HCPCS Left anterior descending … #> 246 LL HCPCS Lease/rental (use the 'll… #> 247 LM HCPCS Left main coronary artery #> 248 LR HCPCS Laboratory round trip #> 249 LS HCPCS Fda-monitored intraocular… #> 250 LT HCPCS Left side (used to identi… #> 251 LU HCPCS Fractionated payment #> 252 M2 HCPCS Medicare secondary payer … #> 253 MA HCPCS Ordering professional is … #> 254 MB HCPCS Ordering professional is … #> 255 MC HCPCS Ordering professional is … #> 256 MD HCPCS Ordering professional is … #> 257 ME HCPCS The order for this servic… #> 258 MF HCPCS The order for this servic… #> 259 MG HCPCS The order for this servic… #> 260 MH HCPCS Unknown if ordering profe… #> 261 MS HCPCS Six month maintenance and… #> 262 N1 HCPCS Group 1 oxygen coverage c… #> 263 N2 HCPCS Group 2 oxygen coverage c… #> 264 N3 HCPCS Group 3 oxygen coverage c… #> 265 NB HCPCS Nebulizer system, any typ… #> 266 NR HCPCS New when rented (use the … #> 267 NU HCPCS New equipment #> 268 P1 HCPCS A normal healthy patient #> 269 P2 HCPCS A patient with mild syste… #> 270 P3 HCPCS A patient with severe sys… #> 271 P4 HCPCS A patient with severe sys… #> 272 P5 HCPCS A moribund patient who is… #> 273 P6 HCPCS A declared brain-dead pat… #> 274 PA HCPCS Surgical or other invasiv… #> 275 PB HCPCS Surgical or other invasiv… #> 276 PC HCPCS Wrong surgery or other in… #> 277 PD HCPCS Diagnostic or related non… #> 278 PI HCPCS Positron emission tomogra… #> 279 PL HCPCS Progressive addition lens… #> 280 PM HCPCS Post mortem #> 281 PN HCPCS Non-excepted service prov… #> 282 PO HCPCS Excepted service provided… #> 283 PS HCPCS Positron emission tomogra… #> 284 PT HCPCS Colorectal cancer screeni… #> 285 Q0 HCPCS Investigational clinical … #> 286 Q1 HCPCS Routine clinical service … #> 287 Q2 HCPCS Demonstration procedure/s… #> 288 Q3 HCPCS Live kidney donor surgery… #> 289 Q4 HCPCS Service for ordering/refe… #> 290 Q5 HCPCS Service furnished under a… #> 291 Q6 HCPCS Service furnished under a… #> 292 Q7 HCPCS One class a finding #> 293 Q8 HCPCS Two class b findings #> 294 Q9 HCPCS One class b and two class… #> 295 QA HCPCS Prescribed amounts of sta… #> 296 QB HCPCS Prescribed amounts of sta… #> 297 QC HCPCS Single channel monitoring #> 298 QD HCPCS Recording and storage in … #> 299 QE HCPCS Prescribed amount of stat… #> 300 QF HCPCS Prescribed amount of stat… #> 301 QG HCPCS Prescribed amount of stat… #> 302 QH HCPCS Oxygen conserving device … #> 303 QJ HCPCS Services/items provided t… #> 304 QK HCPCS Medical direction of two,… #> 305 QL HCPCS Patient pronounced dead a… #> 306 QM HCPCS Ambulance service provide… #> 307 QN HCPCS Ambulance service furnish… #> 308 QP HCPCS Documentation is on file … #> 309 QQ HCPCS Ordering professional con… #> 310 QR HCPCS Prescribed amounts of sta… #> 311 QS HCPCS Monitored anesthesia care… #> 312 QT HCPCS Recording and storage on … #> 313 QW HCPCS Clia waived test #> 314 QX HCPCS Crna service: with medica… #> 315 QY HCPCS Medical direction of one … #> 316 QZ HCPCS Crna service: without med… #> 317 RA HCPCS Replacement of a dme, ort… #> 318 RB HCPCS Replacement of a part of … #> 319 RC HCPCS Right coronary artery #> 320 RD HCPCS Drug provided to benefici… #> 321 RE HCPCS Furnished in full complia… #> 322 RI HCPCS Ramus intermedius coronar… #> 323 RR HCPCS Rental (use the 'rr' modi… #> 324 RT HCPCS Right side (used to ident… #> 325 SA HCPCS Nurse practitioner render… #> 326 SB HCPCS Nurse midwife #> 327 SC HCPCS Medically necessary servi… #> 328 SD HCPCS Services provided by regi… #> 329 SE HCPCS State and/or federally-fu… #> 330 SF HCPCS Second opinion ordered by… #> 331 SG HCPCS Ambulatory surgical cente… #> 332 SH HCPCS Second concurrently admin… #> 333 SJ HCPCS Third or more concurrentl… #> 334 SK HCPCS Member of high risk popul… #> 335 SL HCPCS State supplied vaccine #> 336 SM HCPCS Second surgical opinion #> 337 SN HCPCS Third surgical opinion #> 338 SQ HCPCS Item ordered by home heal… #> 339 SS HCPCS Home infusion services pr… #> 340 ST HCPCS Related to trauma or inju… #> 341 SU HCPCS Procedure performed in ph… #> 342 SV HCPCS Pharmaceuticals delivered… #> 343 SW HCPCS Services provided by a ce… #> 344 SY HCPCS Persons who are in close … #> 345 SZ HCPCS Habilitative services #> 346 T1 HCPCS Left foot, second digit #> 347 T2 HCPCS Left foot, third digit #> 348 T3 HCPCS Left foot, fourth digit #> 349 T4 HCPCS Left foot, fifth digit #> 350 T5 HCPCS Right foot, great toe #> 351 T6 HCPCS Right foot, second digit #> 352 T7 HCPCS Right foot, third digit #> 353 T8 HCPCS Right foot, fourth digit #> 354 T9 HCPCS Right foot, fifth digit #> 355 TA HCPCS Left foot, great toe #> 356 TB HCPCS Drug or biological acquir… #> 357 TC HCPCS Technical component; unde… #> 358 TD HCPCS Rn #> 359 TE HCPCS Lpn/lvn #> 360 TF HCPCS Intermediate level of care #> 361 TG HCPCS Complex/high tech level o… #> 362 TH HCPCS Obstetrical treatment/ser… #> 363 TJ HCPCS Program group, child and/… #> 364 TK HCPCS Extra patient or passenge… #> 365 TL HCPCS Early intervention/indivi… #> 366 TM HCPCS Individualized education … #> 367 TN HCPCS Rural/outside providers' … #> 368 TP HCPCS Medical transport, unload… #> 369 TQ HCPCS Basic life support transp… #> 370 TR HCPCS School-based individualiz… #> 371 TS HCPCS Follow-up service #> 372 TT HCPCS Individualized service pr… #> 373 TU HCPCS Special payment rate, ove… #> 374 TV HCPCS Special payment rates, ho… #> 375 TW HCPCS Back-up equipment #> 376 U1 HCPCS Medicaid level of care 1,… #> 377 U2 HCPCS Medicaid level of care 2,… #> 378 U3 HCPCS Medicaid level of care 3,… #> 379 U4 HCPCS Medicaid level of care 4,… #> 380 U5 HCPCS Medicaid level of care 5,… #> 381 U6 HCPCS Medicaid level of care 6,… #> 382 U7 HCPCS Medicaid level of care 7,… #> 383 U8 HCPCS Medicaid level of care 8,… #> 384 U9 HCPCS Medicaid level of care 9,… #> 385 UA HCPCS Medicaid level of care 10… #> 386 UB HCPCS Medicaid level of care 11… #> 387 UC HCPCS Medicaid level of care 12… #> 388 UD HCPCS Medicaid level of care 13… #> 389 UE HCPCS Used durable medical equi… #> 390 UF HCPCS Services provided in the … #> 391 UG HCPCS Services provided in the … #> 392 UH HCPCS Services provided in the … #> 393 UJ HCPCS Services provided at night #> 394 UK HCPCS Services provided on beha… #> 395 UN HCPCS Two patients served #> 396 UP HCPCS Three patients served #> 397 UQ HCPCS Four patients served #> 398 UR HCPCS Five patients served #> 399 US HCPCS Six or more patients serv… #> 400 V1 HCPCS Demonstration modifier 1 #> 401 V2 HCPCS Demonstration modifier 2 #> 402 V3 HCPCS Demonstration modifier 3 #> 403 V4 HCPCS Demonstration modifier 4 #> 404 V5 HCPCS Vascular catheter (alone … #> 405 V6 HCPCS Arteriovenous graft (or o… #> 406 V7 HCPCS Arteriovenous fistula onl… #> 407 V8 HCPCS Infection present #> 408 V9 HCPCS No infection present #> 409 VM HCPCS Medicare diabetes prevent… #> 410 VP HCPCS Aphakic patient #> 411 X1 HCPCS Continuous/broad services… #> 412 X2 HCPCS Continuous/focused servic… #> 413 X3 HCPCS Episodic/broad servies: f… #> 414 X4 HCPCS Episodic/focused services… #> 415 X5 HCPCS Diagnostic services reque… #> 416 XE HCPCS Separate encounter, a ser… #> 417 XP HCPCS Separate practitioner, a … #> 418 XS HCPCS Separate structure, a ser… #> 419 XU HCPCS Unusual non-overlapping s… #> 420 ZA HCPCS Novartis/sandoz #> 421 ZB HCPCS Pfizer/hospira #> 422 ZC HCPCS Merck/samsung bioepis #> 423 P1 Anesthesia A normal healthy patient Physical Status mod… #> 424 P2 Anesthesia A patient with mild syste… Physical Status mod… #> 425 P3 Anesthesia A patient with severe sys… Physical Status mod… #> 426 P4 Anesthesia A patient with severe sys… Physical Status mod… #> 427 P5 Anesthesia A moribund patient who is… Physical Status mod… #> 428 P6 Anesthesia A declared brain-dead pat… Physical Status mod… #> 429 1P Performance Measure Performance Measure Exclu… Reasons include: No… #> 430 2P Performance Measure Performance Measure Exclu… Reasons include: Pa… #> 431 3P Performance Measure Performance Measure Exclu… Reasons include: Re… #> 432 8P Performance Measure Performance Measure Repor… Modifier 8P is inte… ```

Created on 2024-06-12 with reprex v2.1.0

andrewallenbruce commented 3 months ago

Functional vs. Informational

Assign precedence

andrewallenbruce commented 3 months ago

NCCI Edit Modifiers

Modifiers that may be used to support services included in the NCCI edits.

AnatomicalModifiers <- c(
"E1", "E2", "E3", "E4", 
"FA", "F1", "F2", "F3", "F4", "F5", "F6", "F7", "F8", "F9", 
"LC", "LD", "LM", "LT", "RC", "RI", "RT",
"TA", "T1", "T2", "T3", "T4", "T5", "T6", "T7", "T8", "T9")

GlobalSurgeryModifiers <- c("24", "25", "57", "58", "78", "79", "F2")

OtherModifiers <- c("27", "59", "91", "XE", "XS", "XP", "XU")

Anatomical Modifiers

How should modifier -59 be used under NCCI?

Modifier -59 is used to indicate a distinct procedural service. To appropriately report this modifier, append modifier -59 to the column 2 code to indicate that the procedure or service was independent from other services performed on the same day. The addition of this modifier indicates to the Medicare Administrative Contractors that the procedure or service represents a distinct procedure or service from others billed on the same date of service. In other words, this may represent a different session, different anatomical site or organ system, separate incision/excision, different lesion, or different injury or area of injury (in extensive injuries). When used with a NCCI/CCI edit, modifier -59 indicates that the procedures are different surgeries when performed at different operative areas or at different patient encounters.

If none of the anatomical modifiers can be used appropriately to describe the different sites, then the modifier -59 may be attached to indicate the separate location. Since modifier 59 bypasses many NCCI/CCI edits, providers should use careful consideration before applying this modifier and internal compliance plans should consider appropriate protocols for its application.

Effective January 2015, CMS established four HCPCS modifiers as a subset of the -59 modifier to define a "Distinct Procedural Service." Providers should use the X {ESPU} modifiers in accordance with their published definitions (and perhaps after consultation with their respective MACs) for CMS. Modifier -59 should not be used unless no other more specific modifier is appropriate.

The four modifiers include:

  1. XE (Separate Encounter): A service that is distinct because it occurred during a separate encounter
  2. XS (Separate Structure): A service that is distinct because it was performed on a separate organ/structure
  3. XP (Separate Practitioner): A service that is distinct because it was performed by a different practitioner
  4. XU (Unusual Non-Overlapping Service): The use of a service that is distinct because it does not overlap usual components of the main service

Note, the -X {EPSU} modifiers are more selective versions of the -59 modifier. Thus, it would be incorrect to include both modifiers on the same line.

How should modifier -25 be reported with NCCI/CCI?

Modifier -25 should be appended to an evaluation and management (E/M) code when reported with a separately reportable procedure on the same day of service. Appending modifier -25 to the E/M code indicates to Medicare contractors or fiscal intermediaries that the physician performed a significant, separately identifiable E/M service above and beyond the other service provided.

Modifier -25 may be appended to E&M services reported with minor procedures (global periods of 000 or 010 days) or procedures not covered by global surgery rules (global indicator XXX).

How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit (MUE) value?

Since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary units of service in excess of an MUE value.

CPT modifiers such as -76 (repeat procedure by same physician), -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test), and -59 (distinct procedural service) will accomplish this purpose. Modifier -59 or -X{EPSU} should be utilized only if no other modifier describes the service.

Since this approach bypasses the MUE process, providers should use careful consideration before reporting multiple units of the same service for the same beneficiary on the same calendar date in excess of the MUE values. Internal compliance plans should consider appropriate protocols for any claims exceeding the MUE values.

andrewallenbruce commented 3 months ago

Modifiers

Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code. They are used to add information or change the description of service to improve accuracy or specificity. Modifiers can be alphabetic, numeric or a combination of both, but will always be two digits.

Some modifiers cause automated pricing changes, while others are used for information only. When selecting the appropriate modifier to report on your claim, please ensure that it is valid for the date of service billed.

If more than one modifier is needed, list the payment modifiers—those that affect reimbursement directly—first.

Payment modifiers include: 22, 26, 50, 51, 52, 53, 54, 55, 58, 62, 66, 78, 79, 80, 81, 82, AA, AD, AS, TC, QK, QW, and QY.

Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) should be listed after the payment modifier.

If multiple informational/statistical modifiers apply, you may list them in any order (as long as they are listed after payment modifiers).

Note: It is up to the provider to determine if a modifier applies, and then choose the most appropriate modifier based on medical documentation.

The definition of each modifier can be found within the document linked in the type of modifier column in the chart below.

For modifiers that can be used for more than one topic, please refer to the Additional HCPCS or other CPT for definition.

andrewallenbruce commented 3 months ago

Global surgery & related services

Multiple surgeries

Multiple surgeries are separate procedures performed by a physician on the same patient at the same operative session or on the same day. Multiple surgeries are distinguished from procedures that are components of or incidental to a primary procedure. Intraoperative services, incidental surgeries or components of surgeries will not be separately reimbursed.

Reimbursement is based on the following guidelines for multiple surgical procedures:

The regular multiple surgery rules, as referenced above, will be applied to the procedure codes below when billed for the same beneficiary on the same day, by the same physician.

Nuclear medicine (78802-78803, 78806-78807)

These pricing rules apply to dermatology services:

The limiting charge is 115% of the reduced payment amount for each procedure.

When more than five procedures are performed, reimbursement for the sixth and/or subsequent procedures will be reviewed on an individual consideration basis. Operative notes should be submitted with the claim when five or more surgical procedures are performed during the same operative session.

Reporting guidelines

Novitas does not recommend physician reporting modifier 51 on claims. The claims processing system has hard-coded logic to append the modifier to the correct procedure code/s.

However, if you do report modifier 51, follow the guidelines below:

Example: If you are billing for a repair of a rotator cuff (Code 23412), and a ligament release (code 23415), and a claviculectomy (code 23120), report the codes as follows:

Multiple endoscopy procedures

Endoscopic pricing is identified by an indicator of (3) under the "multiple procedures" field on the fee schedule.

When performing multiple procedures through the same endoscope, payment is made for the highest valued endoscopy (100% of the allowance). The code with the second highest value will be paid at the allowed amount minus the allowed amount for the base code. If there are multiple endoscopic codes and the allowed amount for a code is less than the base code allowed amount it will not be paid.

Example: While performing a fiber optic colonoscopy (CPT code 45378), a physician performs a biopsy on a lesion (code 45380) and removes a polyp (code 45385) from a different part of the colon.

The value of code 45380 and 45385 have the value of the diagnostic colonoscopy built in. Rather than paying 100 percent of the highest valued procedure 45385 and 50 percent for the next 45380, payment is made for the full value of the higher endoscopy (45378), plus the difference between the next highest endoscopy (45380) and the base endoscopy (45378).

Using the fee schedule amounts for the following participating provider base rate as for the state of Texas, the Dallas locality physician would bill procedure codes 45380 and 45385. Payment would be made for the full value of 45385 ($255.08), plus the difference between the 45380 and 45378 ($54.20) for a total of $309.28.

Multiple interventional radiological procedures

If performing multiple interventional radiological procedures, payment for both the radiology code and the primary surgical code is 100% of the fee schedule. Subsequent surgical procedures will be reimbursed according to standard multiple surgery rules.

Global surgical package

The payment for a surgical procedure includes a standard package of preoperative, intraoperative, and postoperative services. The preoperative period included in the global fee for major surgery is 1 day. The postoperative period for major surgery is 90 days. The postoperative period for minor surgery is either 0 or 10 days depending on the procedure. For endoscopic procedures (except procedures requiring an incision), there is no postoperative period.

The Medicare approved amount for these procedures includes payment for the following services related to the surgery when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, e.g., in hospitals, Ambulatory Surgical Centers (ASCs), physicians' offices. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon. However, critical care services (99291 and 99292) are payable separately in some situations.

The following services are included in the payment amount for a global surgery:

The following services are not included in the payment amount for a global surgery:

For minor surgeries and endoscopies, the Medicare program will not pay separately for an evaluation & management service on the same day as a minor surgery or endoscopy, unless a significant, separately identifiable service is also performed, for example, an initial consultation or initial new patient visit. As stated earlier, there is no postoperative period for endoscopic procedures (unless an incision is required) and minor surgical procedures have postoperative periods of 0 or 10 days, based on the procedure.

Add-On surgical procedures

CMS has assigned various surgical procedures with global surgery post-operative periods of "ZZZ".

These procedures, while surgical in nature, are add-on codes that are always billed with another procedure. There is no post-operative work included in the fee schedule amount for "ZZZ" codes.

When billed independent of another qualifying service, "ZZZ" procedures will be denied since they, by definition, are not stand-alone procedures. When billed in conjunction with a primary surgical procedure or qualifying service, both the primary and add-on code will be paid. The global surgery rules apply to the primary procedure.

Splitting post-operative care

Specific billing guidelines must be followed when the surgical procedure and the post-operative care is split between different physicians.

Modifiers 54 and 55 are used to indicate that two different physicians are rendering the surgical care and post-operative management services. The physician who is rendering the one-day preoperative care, the intraoperative services, and any in-hospital visits bills his/her services with the date of the surgery, the procedure code for the surgery, and a 54 modifier to indicate that the bill is reflective only of the surgical care.

The physician rendering the postoperative, out of hospital care associated with a given surgical procedure should bill for his/her services with the date of the surgery, the procedure code for the surgery, and a 55 modifier. If the surgeon also cares for the patient for some period following discharge, the surgeon should bill the surgery with a 55 modifier and indicate the portion of the post-op care provided in addition to the surgery with a 54 modifier (to indicate the intra-operative service).

In those cases where the postoperative care is "split" between physicians, the billing for the postoperative care should be reported as follows:

Both the surgeon and the physician(s) providing the post-operative care must keep a copy of the written transfer agreement in the beneficiary's medical records. Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service. Once the physician has seen the patient, that physician may bill for the period beginning with the date on which he/she assumes care of the patient.

Where physicians agree on the transfer of care during the global period, the following modifiers are used:

Both the bill for the surgical care only and the bill for the postoperative care only, will contain the same date of service and the same surgical procedure code, with the services distinguished by the use of the appropriate modifier.

Providers must report the date post-operative care began and ended along with the number of post-operative care days provided on which care was relinquished or assumed. Both the surgeon and the physician(s) providing the post-operative care must keep a copy of the written transfer agreement in the beneficiary's medical records.

Billing example

Physician A performs a hysterectomy (58150) on 04/15/2021 in the hospital. The procedure has a 90-day global period. The patient was in the hospital for 8 days until 04/23/2021 during which time physician A administered post-operative care. On 04/24/2021, physician B took over the post-operative care, which was administered in the office.

Bilateral procedures

Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day. CMS has defined codes subject to the bilateral payment rule. Payment for claims reporting bilateral procedures is 150% of the fee schedule amount. The limiting charge is 115% of that amount.

Procedure codes containing the terms "bilateral" or "unilateral or bilateral" in their definitions are not subject to bilateral pricing. Payment for these services is 100% of the fee schedule for a surgical code. Procedure codes with terminology indicative of unilateral or bilateral services, as in code 27395 (lengthening of hamstring tendon; multiple, bilateral) or code 52290 (Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral) cannot be reported with the bilateral procedure code modifier 50 since the terminology for the code identifies the service as bilateral.

Certain procedures are not applicable to the 150% payment rule for bilateral procedures. Payment is 100% of the fee schedule for each side, e.g., codes 92225 and 92226. When performed bilaterally, report the codes with modifiers RT-LT or 50 to ensure proper payment.

Reporting guidelines

For example, if you bill a bilateral mastectomy, report the service as a single line item: 19303 50.