Primary care physicians can get the revenue they deserve by properly using codes that indicate they provided multiple services in a single patient encounter.
Family physicians often perform multiple services in a single patient encounter. This provides access to comprehensive care with a convenience that both the physician and patient appreciate. But physicians do not get paid for all of their work if they don't attach the correct modifiers in the office encounter.
Modifiers have many purposes and applications. They can indicate when an encounter has both professional and technical components, when a procedure was partially completed or discontinued, and when multiple procedures or services are provided on the same date. Using a modifier does not always result in physicians receiving complete reimbursement for every service as requested, but may allow for at least partial payment. Some estimates indicate that missed modifiers could result in up to $120 of lost revenue per applicable visit.1 This can be very costly when you consider that family physicians see 60–80 office visits per week on average.2
This article explains how to use some of the modifiers most common in primary care, which are also listed in Table 1.
KEY POINTS
- Modifier 25 is a “multitasking modifier” that indicates to the payer that the clinician performed separate but significant services to the patient in one encounter.
- Services partially completed or discontinued can still be billed using modifier 52 and modifier 53, respectively.
- Modifiers may be required when reporting telemedicine services, including audio-only. But these rules are in flux post-pandemic and it's best to check with individual payers.
TABLE 1. LIST OF MODIFIERS AND DEFINITIONS
| Alphanumeric code | Definition |
|---|---|
| 24 | Unrelated E/M service by the same physician in the postoperative period |
| 25 | Separate, significantly identifiable E/M services |
| 26 | Only performed professional component (PC) |
| 50 | Bilateral procedures |
| 52 | Reduced services (e.g., bilateral code performed unilaterally) |
| 53 | Discontinued procedure |
| 59 | Distinct procedural services on the same day that are not normally reported together |
| 76 | Repeat procedure, same physician |
| 77 | Repeat procedure, another physician |
| PC | Professional component |
| TC | Technical component |
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