[Verified Answer]: “If it isn’t coded, then it hasn’t been done”…

“If it isn’t coded, then it hasn’t been done” is a proverb that isn’t heard in the healthcare setting frequently enough. Correctly applying modifiers, though, isn’t always as cut and dry as it seems. Many times, providers inappropriately use modifiers, an abuse that inevitably leads to claim denials. CPT modifiers (also referred to as Level I modifiers) are used to supplement information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition. Learn more about CPT modifiers at Medical Coding Modifiers – CPT®, NCCI & HCPCS Level IILinks to an external site. and then complete the following. (Only read the section on CPT modifiers) Choose a modifier and write a scenario that might appear in the physician’s notes that would lead you to use that modifier. Example 1: Ronald Aswan, a 15-year-old male, came to Dr. Pollard to have corrective surgery on both of his eyes. The modifier used would be -50 to indicate the procedure was done on BOTH eyes—a bilateral procedure. Example 2: John Jung, a 2-week-old male, was rushed into surgery for repair of a septal defect. If the repair is not completed successfully, he may not survive. The correct anesthesia physical status modifier is -P5. Explain your rationale (reasoning) for your scenario leading to the use of the modifier. Is it justified? Could it be disputed?