|CPTM1_n - First CPT-4/HCPCS modifier
|State Specific Notes
Two-digit modifiers for CPT and HCPCS codes indicate that a service or procedure that has been performed has been altered by some specific circumstances, but not changed in its definition. Examples include the following:
More than one modifier may be used for an individual HCPCS/CPT code. When billing HCPCS/CPT codes with more than one modifier, the functional modifier is supposed to be placed in the first modifier field. Informational modifiers should be placed in the second modifier field. For example, if a physician billed a CPT code with both the modifier 22 for unusual services and the modifier LT to indicate the procedure was performed on the left side of the body, the 22 would be placed in the first modifier field and the LT would be placed in the second modifier field.
During HCUP processing, modifiers are validated. Invalid modifiers are set to "i".
|State Specific Notes
This data element was provided by Utah for ambulatory surgery (AS) records and not supplied for the emergency department (ED) records. However, when AS records with evidence of ED services were placed in the SEDD during HCUP processing, this data element was also added to the SEDD. Therefore, very few records in the SEDD will contain values for this data element.
For 2005, the CPT modifier array for Wisconsin will only identify bilateral procedure codes. Wisconsin provided a Bilateral Procedure Indicator for each CPT field on the outpatient source files. These indicators identified bilateral procedures based upon submission of modifier "50" on outpatient surgery or emergency department records. During HCUP processing, the HCUP variable CPTM1_n was coded with the value "50" whenever this indicator was set to "Y". No other values will be found in the modifier array for Wisconsin SASD or SEDD.
Beginning in 2006, Wisconsin provided CPT modifiers and the Bilateral Procedure Indicators are no longer used.
|Internet Citation: HCUP Central Distributor SEDD Description of Data Elements - All States. Healthcare Cost and Utilization Project (HCUP). September 2008. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/sedddistnote.jsp?var=cptm1_n.
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|Last modified 9/11/08