CPT modifiers cheat sheet for the CPC exam

E/M modifiers

• 25: a significant, separately identifiable E/M service on the same day as a procedure or other service, by the same provider. The E/M must stand on its own, beyond the usual pre- and post-procedure work.
• 57: an E/M service that resulted in the decision for surgery, for a major procedure (90-day global) on the day of or day before.
• 24: an unrelated E/M service during a postoperative period.

Distinct procedures: 59 and the X modifiers

Modifier 59 identifies a procedure as distinct or independent from another performed the same day, when the two would normally be bundled. The more specific HCPCS modifiers say why: XE (separate encounter), XS (separate structure), XP (separate practitioner) and XU (unusual, non-overlapping service). Payers watch 59 closely; use it only when the documentation shows a genuinely separate service, and never just to get past a bundling edit.

Multiple, bilateral and component modifiers

• 51: multiple procedures in the same session by the same provider.
• 50: a bilateral procedure performed on both sides in the same session. LT and RT identify a single side.
• 26: the professional component only, such as a physician's interpretation.
• TC: the technical component only, such as the equipment and technician.

Repeat and global-period modifiers

• 76: a repeat procedure by the same physician; 77: by another physician.
• 78: an unplanned return to the operating or procedure room for a related procedure during the postoperative period.
• 79: an unrelated procedure during the postoperative period.
• 22: substantially increased procedural services, which must be documented; 52: reduced services; 53: a discontinued procedure.