Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MODIFIER AND CODE RULES › Section 20-2-II - MODIFIERS APPROVED FOR AMBULATORY SURGERY CENTER (ASC) AND HOSPITAL OUTPATIENT USE

Current through June 25, 2024
This section contains a list of modifiers used with
				  ambulatory surgery center and hospital-based outpatient services.
25 Significant, Separately Identifiable
				  Evaluation and Management Service by the Same Physician or Other Qualified
				  Health Care Professional on the Same Day of the Procedure or Other
				  Service
It may be necessary to indicate that on the day a procedure
				  or service identified by a CPT code was performed, the patient's condition
				  required a significant, separately identifiable E/M service above and beyond
				  the other service provided or beyond the usual preoperative and postoperative
				  care associated with the procedure that was performed. A significant,
				  separately identifiable E/M service is defined or substantiated by
				  documentation that satisfies the relevant criteria for the respective E/M
				  service to be reported (See Evaluation and Management Services Guidelines for
				  instructions on determining level of E/M service.) The E/M service may be
				  prompted by the symptom or condition for which the procedure and/or service was
				  provided. As such, different diagnoses are not required for reporting of the
				  E/M services on the same date. This circumstance may be reported by adding
				  modifier 25 to the appropriate level of E/M service. Note: This modifier is not
				  used to report an E/M service that resulted in a decision to perform surgery.
				  See modifier 57. For significant, separately identifiable non-E/M services, see
				  modifier 59.
27 Multiple Outpatient Hospital E/M Encounters
				  on the Same Date
For hospital outpatient reporting purposes, utilization of
				  hospital resources related to separate and distinct E/M encounters performed in
				  multiple outpatient hospital settings on the same date may be reported by
				  adding modifier 27 to each appropriate level outpatient and/or emergency
				  department E/M code(s). This modifier provides a means of reporting
				  circumstances involving evaluation and management services provided by
				  physician(s) in more than one (multiple) outpatient hospital setting(s) (eg,
				  hospital emergency department, clinic). Note: This modifier is not to be used
				  for physician reporting of multiple E/M services performed by the same
				  physician on the same date. For physician reporting of all outpatient
				  evaluation and management services provided by the same physician on the same
				  date and performed in multiple outpatient setting(s) (eg, hospital emergency
				  department, clinic), see Evaluation and Management, Emergency Department, or
				  Preventive Medicine Services codes.
50 Bilateral Procedure
Unless otherwise identified in the listings, bilateral
				  procedures that are performed at the same session, should be identified by
				  adding modifier 50 to the appropriate five-digit code.
Mississippi guideline: This modifier is reimbursed at
				  fifty percent (50%) of the maximum allowable reimbursement, unless the
				  procedure is included in the Pain Management section, where this modifier is
				  reimbursed at twenty-five percent (25%) of the maximum allowable reimbursement.
52 Reduced Services
Under certain circumstances a service or procedure is
				  partially reduced or eliminated at the discretion of the physician or other
				  qualified health care professional. Under these circumstances the service
				  provided can be identified by its usual procedure number and the addition of
				  modifier 52, signifying that the service is reduced. This provides a means of
				  reporting reduced services without disturbing the identification of the basic
				  service. Note: For hospital outpatient reporting of a previously scheduled
				  procedure/service that is partially reduced or cancelled as a result of
				  extenuating circumstances or those that threaten the well-being of the patient
				  prior to or after administration of anesthesia, see modifiers 73 and 74.
58 Staged or Related Procedure or Service by the Same
				  Physician or Other Qualified Health Care Professional During the Postoperative
				  Period
It may be necessary to indicate that the performance of a
				  procedure or service during the postoperative period was:
(a) planned or anticipated
				(staged);
(b) more extensive than
				the original procedure; or
(c)  for
				therapy following a diagnostic surgical procedure. This circumstance may be
				reported by adding modifier 58 to the staged or related procedure. Note: For
				treatment of a problem that requires a return to the operating/procedure room
				(eg, unanticipated clinical condition), see modifier 78.
59 Distinct Procedural Service
Under certain circumstances, it may be necessary to indicate
				  that a procedure or service was distinct or independent from other non-E/M
				  services performed on the same day. Modifier 59 is used to identify
				  procedures/services other than E/M services that are not normally reported
				  together, but are appropriate under the circumstances. Documentation must
				  support a different session, different procedure or surgery, different site or
				  organ system, separate incision/excision, separate lesion, or separate injury
				  (or area of injury in extensive injuries) not ordinarily encountered or
				  performed on the same day by the same individual. However, when another already
				  established modifier is appropriate, it should be used rather than modifier 59
				  Only if no more descriptive modifier is available, and the use of modifier 59
				  best explains the circumstances, should modifier 59 be used. Note: Modifier 59
				  should not be appended to an E/M service. To report a separate and distinct E/M
				  service with a non-E/M service performed on the same date, see modifier 25. See
				  also Level II (HCPCS/National) Modifiers listing.
73 Discontinued Out-Patient Hospital/Ambulatory
				  Surgery Center (ASC) Procedure Prior to the Administration of
				  Anesthesia
Due to extenuating circumstances or those that threaten the
				  well being of the patient, the physician may cancel a surgical or diagnostic
				  procedure subsequent to the patient's surgical preparation (including sedation
				  when provided, and being taken to the room where the procedure is to be
				  performed), but prior to the administration of anesthesia (local, regional
				  block(s) or general). Under these circumstances, the intended service that is
				  prepared for but cancelled can be reported by its usual procedure number and
				  the addition of modifier 73. Note: The elective cancellation of a service prior
				  to the administration of anesthesia and/or surgical preparation of the patient
				  should not be reported. For physician reporting of a discontinued procedure,
				  see modifier 53.
74 Discontinued Out-Patient Hospital/Ambulatory
				  Surgery Center (ASC) Procedure After Administration of Anesthesia
Due to extenuating circumstances or those that threaten the
				  well-being of the patient, the physician may terminate a surgical or diagnostic
				  procedure after the administration of anesthesia (local, regional block(s),
				  general) or after the procedure was started (incision made, intubation started,
				  scope inserted, etc). Under these circumstances, the procedure started but
				  terminated can be reported by its usual procedure number and the addition of
				  modifier 74. Note: The elective cancellation of a service prior to the
				  administration of anesthesia and/or surgical preparation of the patient should
				  not be reported. For physician reporting of a discontinued procedure, see
				  modifier 53.
76 Repeat Procedure or Service by Same
				  Physician or Other Qualified Health Care Professional
It may be
				  necessary to indicate that a procedure or service was repeated by the same
				  physician or other qualified health care professional subsequent to the
				  original procedure or service. This circumstance may be reported by adding
				  modifier 76 to the repeated procedure or service. Note: This modifier should
				  not be appended to an E/M service.
77 Repeat Procedure by Another Physician or
				  Other Qualified Health Care Professional
It may be necessary to indicate that a basic procedure or
				  service was repeated by another physician or other qualified health care
				  professional subsequent to the original procedure or service. This circumstance
				  may be reported by adding modifier 77 to the repeated procedure or service.
				  Note: This modifier should not be appended to an E/M service.
78 Unplanned Return to the Operating/Procedure
				  Room by the same Physician or Other Qualified Health Care Professional
				  Following Initial Procedure for a Related Procedure During the Postoperative
				  Period
It may be necessary to indicate that another procedure was
				  performed during the postoperative period of the initial procedure (unplanned
				  procedure following initial procedure). When this procedure is related to the
				  first, and requires the use of an operating/procedure room, it may be reported
				  by adding modifier 78 to the related procedure. (For repeat procedures, see
				  modifier 76.)
79 Unrelated Procedure or Service by the Same
				  Physician or Other Qualified Health Care Professional During the Postoperative
				  Period
The individual may need to indicate that the performance of a
				  procedure or service during the postoperative period was unrelated to the
				  original procedure. This circumstance may be reported by using modifier 79.
				  (For repeat procedures on the same day, see modifier 76.)
91 Repeat Clinical Diagnostic Laboratory
				  Test
In the course of treatment of the patient, it may be
				  necessary to repeat the same laboratory test on the same day to obtain
				  subsequent (multiple) test results. Under these circumstances, the laboratory
				  test performed can be identified by its usual procedure number and the addition
				  of modifier 91. Note: This modifier may not be used when tests are rerun to
				  confirm initial results; due to testing problems with specimens or equipment;
				  or for any other reason when a normal, one-time, reportable result is all that
				  is required. This modifier may not be used when other code(s) describe a series
				  of test results (eg, glucose tolerance tests, evocative/suppression testing).
				  This modifier may only be used for laboratory test(s) performed more than once
				  on the same day on the same patient.