E/M provided by the same physician on the same day as a procedure or other service. The E/M must be above and beyond the pre/post-operative work.

E/M by the same physician during a postoperative period for a problem unrelated to the original surgery. Requires documentation clearly showing the unrelated nature.

An E/M service that resulted in the initial decision to perform surgery. Append to E/M when the surgery is a major procedure (90-day global period) and the decision is made the day before or day of surgery.

Services mandated by a regulatory or government agency, third party payer, or referring physician.

The work required to provide the service was substantially greater than typically required. Must be accompanied by documentation explaining the increased work — increased intensity, time, technical difficulty, or severity of condition.

Regional or general anesthesia administered by the operating surgeon. Do not use for local anesthesia.

Unless otherwise identified in the listings, bilateral procedures performed at the same session should be identified by adding modifier 50.

When multiple procedures are performed at the same session by the same provider, the primary procedure should be reported first. Subsequent procedures are reported with modifier 51. CMS has a list of modifier 51 exempt codes.

Under certain circumstances a service is partially reduced or eliminated at the physician's discretion. Does not apply to professional components.

Physician elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or threat to the patient's well-being after the patient was prepared but before general anesthesia (see 73/74 for facility).

When one physician performs a surgical procedure and another provides preoperative and/or postoperative care.

When one physician performed the postoperative management and another physician performed the surgical procedure.

When one physician performed the preoperative care and evaluation and another performed the surgical procedure.

The surgeon performing a staged, related, or similar procedure during the postoperative period of a previous procedure. Not used for unplanned return (see 78).

A procedure or service distinct or independent from other non-E/M services performed on the same day. Use only when a more specific modifier (XE, XS, XP, XU) is not available.

When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon reports the procedure with modifier 62.

Procedures performed on neonates and infants up to a present body weight of 4 kg. Indicates the additional complexity of procedures in this patient population.

Highly complex procedures requiring the concomitant services of several physicians, each with specific skills. Only for procedures where team surgery is specified in payer guidelines.

Outpatient hospital/ASC procedure cancelled after patient prepared and taken to room but before anesthesia administered. Facility use.

Outpatient hospital/ASC procedure cancelled after administration of anesthesia or after procedure was started. Facility use.

Repeat procedure performed by the same physician or other QHP subsequent to the original procedure.

Repeat procedure performed by a different physician or other QHP.

Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period.

Procedure performed by same surgeon during the postoperative period for an unrelated condition. A new postoperative period begins with the subsequent procedure.

Surgical assistant services may be identified by adding modifier 80 to the usual procedure code.

Minimum surgical assistant services are identified by adding modifier 81 to the usual procedure code.

When a qualified resident is unavailable, a second physician may serve as assistant. Used only in teaching hospitals. Submit documentation of unavailability.

Service performed in part by a resident under the direction of a teaching physician. The teaching physician must be present during key portions of the service.

Service furnished by a locum tenens physician. The regular physician must arrange and pay the locum tenens.

A service that is distinct because it occurred during a separate encounter from other services billed on the same date.

A service that is distinct because it was performed on a separate organ/structure. Common in bilateral procedures or multi-site interventions.

A service that is distinct because it was performed by a different practitioner than the one who performed the other service on the same date.

A service that is distinct because it does not overlap the usual components of the main service. Narrowest of the X-modifiers.

Appended when reporting only the physician's interpretation and written report. The technical component (equipment, personnel) is billed separately.

Appended to report only the technical component of a procedure (equipment, supplies, non-physician staff). Used by facilities/hospitals.