Modifier 56 | Preoperative Management Only Explained

Modifier 56 describes preoperative management only, which is one of the three components of a surgical package.

1. What is modifier 56?

Modifier 56 is a CPT code modifier that indicates that the provider has rendered only preoperative management. This modifier is used when the provider has not provided intraoperative or postoperative services.

2. When to use modifier 56?

Modifier 56 is used when the provider renders the preoperative management but does not provide intraoperative or postoperative services. For example, this may occur when different providers render different components of care or when a provider transfers the patient’s care to another provider.

3. Description

The official description of modifier 56 is “preoperative management only”.

4. Examples

Examples of procedures requiring modifier 56 include preoperative consultations, preoperative testing, and preoperative instructions.

5. Documentation

To use modifier 56, the medical record must document that the provider has rendered preoperative management only. The documentation should include the date of the preoperative service, the nature of the service, and the reason why the provider did not provide the intraoperative or postoperative services.

6. Billing

When billing for a procedure with modifier 56, the provider should append the modifier to the procedure code. The provider should also list the provider who rendered the intraoperative services in block 31 of the CMS 1500 claim form.

7. Common mistakes

Common mistakes that medical coders make when using modifier 56 include using the modifier when the provider has provided intraoperative or postoperative services, failing to document the preoperative service, and failing to list the provider who rendered the intraoperative services in block 31 of the CMS 1500 claim form. Medical coders should carefully review the medical record and follow the documentation and billing guidelines to avoid these mistakes.

8. Other modifiers related to modifier 56

Other modifiers related to modifier 56 include modifier 54, which represents surgical care only, and modifier 55, which represents postoperative management only.

9. Tips

When using modifier 56, medical coders should ensure that the documentation supports the use of the modifier and that the billing is accurate and follows the guidelines.