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Modifier Coding Cheat sheetHow to Add Modifiers to an InvoiceGynaecology & Obstetrics Modifier CheatsheetPaediatric Modifier Cheatsheet

Gynaecology & Obstetrics Modifier Cheatsheet

0018

High BMI

+50%

BMI of 35 or greater. Only applicable to incisional procedures. Height and weight needed.

0005

Reduction modifier

Multiple proceduressame anesthetic

Add after all procedure codes have been added. Add to all procedure codes unless a code specifies 0005 doesn't apply. Not for consultation items, add-on codes, or nerve blocks.

0007

Own monitoring equipment

+15 units

Rooms: for procedures under IV sedation. Hospital/unattached theatre: where the appropriate equipment isn't provided by the hospital.

0074

Endoscopic procedures, own equipment

+33.33%

Of the procedure fee, if the doctor owns the endoscopic equipment.

0075

Endoscopic procedures, own rooms

—

Doctor must own or pay rent for the rooms.

0013

Endoscopic examination under anesthesia

50%

If a related endoscopic examination is done at the same operation, only 50% of the endoscopy units may be charged (e.g. cystoscopy with bladder repair).

0008

Specialist surgeon assistant

33.33% / 40%

Calculate using all procedure codes and modifiers except 0011. Use only if a specialist assistant is imperative — otherwise use 0009.

0009

Assistant

20%min. 36 units

Calculate using all procedure codes and modifiers except 0011.

Also relevant: 1807 — add for laparoscopic procedures, unless the procedure code already specifies laparoscopic (e.g. 2340 Laparoscopic.

Building a gynaecology/obstetric surgical claim

Same principle as any surgical claim in Nova. This order is fixed — skip steps that don't apply, but never reorder the ones that do.

  1. Procedure line(s), highest value first - Order procedure codes from highest unit value to lowest. Modifiers can only reference lines already above them.
  2. If BMI is greater than 35 the  0018(High BMI modifier) - Must come before 0009 so it appears in the Apply to list when the assistant fee is calculated.
  3. If emergency 0011(Surgeon's emergency time) - Applies to C-sections. Does not apply to vaginal deliveries.
  4. If assistant is present 0009 or 0008(Assistant fee) - Added last so all applicable procedures and modifiers (e.g. 0018) are in the "Apply to" list. Calculated on all procedure codes and modifiers except 0011.
  5. If emergency + assistant 0011(Assistant's emergency time) - A separate 0011 line for the assisting doctor — added after 0009/0008, not grouped with the surgeon's 0011.

Critical rules

  1. Emergency time (0011) applies to C-sections, not vaginal deliveries. Adding 0011 to a vaginal delivery claim is incorrect regardless of how urgent the delivery was.
  2. Mutually exclusive codes can't be combined. Many codes already accommodate services specified in other codes — e.g. 2443 (Dilatation and Curettage) may not be used together with 2437 (Hysteroscopy and sampling of endometrium and/or polypectomy, with or without D&C). Refer to the SASOG guide for the full list.
  3. Procedures must be added before modifiers, highest value first. The Apply to list only shows lines already above the modifier on the invoice.
  4. 0005 goes on every procedure code, with exceptions. Add it to all procedure codes done under the same anaesthetic unless a specific code states 0005 doesn't apply to it.
  5. 1807 (laparoscopic addition) isn't always needed. Skip it when the procedure code itself already specifies laparoscopic (e.g. 2340).


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