Coding HCPCS Level II Modifiers
There are numerous HCPCS Level II modifiers; many more than CPT modifiers. HCPCS Level II modifiers are two-character codes that may be two alphabetic characters (AA) or one alphabetic character and one numeric character (U4).
HCPCS Level II modifiers are required to add specificity to CPT procedure codes performed on eyelids, fingers, toes, and coronary arteries.
HCPCS modifiers assist the payers in identifying circumstances for payment. As an example, when a substitute physician takes over the professional practice of a physician who is absent for reasons such as illness, pregnancy, vacation, or continuing medical education, the service is reported under the regular physician with a modifier Q6 appended to the services. The Q6 modifier indicates to the payer that the service was provided by the substitute physician. This was previously known as locum tenens.
You will want to review the HCPCS Level II code book for the full listing and descriptors. A complete list of HCPCS modifiers approved for hospital outpatient use is also listed on the inside of the front cover of the CPT code book as an additional reference.
Q: What would the CPT and HCPCS modifier be for an excision of chalazion left upper eyelid and a biopsy of the left lower eyelid margin performed during the same operative session?
A: 67800-E1, 67810-E2 Rationale: 67800 would describe the excision of chalazion; single, and 67810 is supported for the incisional biopsy of eyelid skin including lid margin. Modifier E1 is the appropriate HCPCS modifier for the upper left, eyelid, and E2 supports the lower left eyelid.
Reference: FY 2023 CPT code book, FY 2023 HCPCS code book
