Description :

E1   Upper left, eyelid
E2   Lower left, eyelid
E3   Upper right, eyelid
E4   Lower right, eyelid

FA  Left hand, thumb
F1  Left hand, second digit
F2  Left hand, third digit
F3  Left hand, fourth digit
F4  Left hand, fifth digit
F5  Right hand, thumb
F6  Right hand, second digit
F7  Right hand, third digit
F8  Right hand, fourth digit
F9  Right hand, fifth digit

FA Left hand, thumb

LC Left circumflex coronary artery

LD Left anterior descending coronary artery

LM Left main coronary artery

LT Left side

RC Right coronary artery

RI Ramus intermedius coronary artery

RT Right side


Feet Modifiers


Modifier Modifier Description

TA  Left foot, great toe
T1   Left foot, second digit
T2   Left foot, third digit
T3   Left foot, fourth digit
T4   Left foot, fifth digit
T5   Right foot, great toe
T6   Right foot, second digit
T7   Right foot, third digit
T8   Right foot, fourth digit
T9   Right foot, fifth digit


Modifiers TA and T1-T9

When billing toe or toenail surgeries, Modifiers TA and T1-T9 are necessary to ensure services are processed and paid correctly.

HCPCS Level II toe Modifiers TA and T1-T9 are anatomical modifiers that describe procedures performed on the right and left foot digits. It is incorrect to additionally append Modifiers LT and/or RT. It is also incorrect to use modifier 59 and/or modifier 59 subset “X modifiers” (XE, XS, XP, XU).

Failure to use these modifiers appropriately may result in claims denial. Additionally, post audits will be performed and will result in recoupments if documentation reviewed supports unbundling by incorrect use of modifiers 59, XE, XS, XP, XU, LT and RT.

Required for Claims : Hospital Outpatient Prospective Payment System

Type of Bill : 13X

Coding Guidelines : Generally applied to surgical (CPT 10000-69990) and other diagnostic services
(CPT 90281-99569)

General Guidelines :

*  Apply the appropriate modifiers for procedures involving eyelids, fingers and toes.  Use the most specific modifier available.

* If more than one level II modifier applies, repeat each line item with the appropriate level II modifiers

*  Do not use if CPT/HCPCS code indicates multiple occurrences.

*  Do not use if the code indicates the procedure applies to different body parts.

Example: Patient comes to the hospital for drainage of an abscess on the fifth digit on the right hand.

BILLING:


26010 Drainage of finger abscess; simple (Use appropriate modifier to identify the fifth digit on the right hand)

Billing Guide to Avoid Medically unlikely Edit

some instances, it may be appropriate for a provider to report medically reasonable and necessary units of service in excess of a MUE value. Since each line of a claim is adjudicated separately against the MUE value for the code on that line, appropriate CPT modifiers should be used 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 should be utilized only if no other modifier describes the service

The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, RC, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, 25, 27, 58, 59, 78, 79, and 91. Additional modifiers shall be added to the above list of NCCI-associated modifiers that will allow an edit with modifier indicator of “1” to be bypassed when the modifier is utilized correctly. These modifiers are LM (left main coronary artery), RI (ramus intermedius coronary artery), 24 (unrelated evaluation and management service by the same physician during a postoperative period), and 57 (decision for surgery).

*  Procedure codes that do not specify right or left require an anatomical modifier. If an anatomical modifier is necessary to differentiate right or left and is not appended, the claim will be denied.

* Likewise, if a modifier is appended to a procedure code that does not match the appropriate anatomical site, the claim will be denied.

* Please append the modifier in 24D of the CMS 1500 claim form, or electronically report the first modifier in SV101-3; use the additional fields SV101-4, SV101-5 or SV101-6 if needed for additional modifiers relevant to the procedure code on the service line.

Would the Maximum Frequency Day value for hand or foot bilateral procedures remain at “1” unit if it is possible to perform the procedure on multiple digits such as fingers or toes?

The MFD value would remain at 1 unit, however, HCPCS modifiers FA or F1-9 may be used to report specific fingers; TA or T1-9 may be used to report specific toes.

Modifier TH – Obstetrical treatment/services

Policy The Plan recognizes Modifier TH appended to a An Evaluation and Management (E&M) service to indicate the first, second or third routine antepartum visit when a p
rovider renders  less than the  number of antepartum visits designated in code  59425 – Antepartum care only; 4-6 visits or code  59426- Antepartum care only; 7 or more visits.

  
Modifier TH is appropriate  only  when added to an E&M code to represent three or less visits for routine antepartum care
.
Modifier TH should notbe billed on any post – partum E&M  visit code

.
Violations of Policy

Violations of this policy by any party that enters into a written arrangement with the  Plan may result in increased auditing and monitoring, performance guarantee contractual penalties and/or termination of the contract.   Disciplinary actions will be appropriate to the seriousness of the violation and shall be determined in Plan’s sole discretion.

Violations of this policy may be grounds for corrective action, up to and including  termination of employment.