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Modifiers and Their Significance in Medical Coding


With billions of people getting affected by illnesses and diseases, it is a tough job to report all the details regarding the patients’ visits to healthcare facilities. This is all the more difficult when there are multiple healthcare facilities and the same patient may visit a physician multiple times. To ease the process of reporting these details for future references and for insurance purpose, medical codes are used and medical coding has become one of the most significant professions in the healthcare sector. Medical coding involves taking medical reports from healthcare providers which include patients’ conditions, diagnoses, treatment provided and translating them into a set of codes as per the international standards. Coding modifiers accurately is absolutely necessary to get the due revenues for a healthcare provider which can be learnt by enthusiastic medical coders at the best medical coding company in Hyderabad. There are three types of codes that are used in medical coding jobs – ICD, CPT and HCPCS codes.


As the medical diagnoses and procedures are too complex in nature, sometimes a need for some additional information arises at the time of coding. In such cases, the need for modifying codes arises which provide additional information about the procedures. To see success in medical coding jobs, it is of utmost importance to know the various modifiers as they are critical in coding and using them wrongly may result in revenue losses.

Modifiers are those codes that describe if a service or procedure has been modified under some circumstances. They give additional information or change the description per the physician’s documentation to give more specific details for a service or procedure performed. Modifier codes consist of 2 digits and can be categorized into two levels. They are:

  • Level I modifiers: These are also known as the CPT modifiers and consist of 2 alphanumeric characters which are updated once a year by the American Medical Association (AMA). These modifiers are added at the end of a CPT code with a hyphen. In cases where there is more than one modifier that has to be mentioned, first, the functional modifier has to be listed and then the informational modifier. Anesthesia procedures have a special set of modifiers to state the condition of a patient when anesthesia is administered.
  • Level II modifiers: These are also known as HCPCS modifiers and consist of 2 alphanumeric characters which are updated once a year by the Centers for Medicare and Medicaid Services (CMS). These modifiers are used to give additional specification to a procedure performed and can impact the claim payments.

The modifiers play a crucial role in medical coding field as they are vital in medical claims processing. Modifiers give clarity on the following aspects to insurance payers.

  1. If the provided services included technical component or professional component or both
  2. If more than one physician has rendered a service or procedure
  3. If service was rendered at more than one location
  4. If service was performed completely or partially
  5. If any optional extra service or bilateral service was performed
  6. If a service was performed multiple times
  7. If any mishap occurred while providing the service

Thus, the modifiers play a significant role in the accuracy of medical coding and billing. Hence, a proficient medical coder is required to do this job. Avontix is one of the best medical coding companies in Hyderabad that gives aspiring medical coders great scope of experience and growth. 

Visit: Avontix

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