Use P Mods to Put Patent Health Info at Forefront of Claims

Posted on 8 Mar, 2016 |comments_icon 0|By Chris Boucher

P modifiers help to ID patient health at time of anesthesia.

Whenever you are filing a claim that involves anesthesia administration, be sure to include a physical status (“P”) modifier on any anesthesia codes.

Reason: The modifiers put a spotlight on the patient’s health at the time of the anesthesia administration. There is always the risk of adverse reaction when a patient needs anesthesia, and you’ll need P modifiers to reflect the specifics of the situation.

Find out the inner meaning of P modifiers with this quick lesson in representing the physical status of patients receiving anesthesia.

Show Potential Risk with P1-P6

Anesthesiologists use modifiers P1-P6 to indicate the overall health of the patient, as this is a factor in anesthesia administration.

According to Leslie Johnson, CPC, CSFAC, chief coding officer at PRN Advisors in Palm Coast, Fla.:

  • Modifiers P1 (A normal healthy patient) and P2 (A patient with mild systemic disease)“indicate minimal to no risk to the patient during the surgery. Generally most people under the age of 30ish will fall into this category,” she says.
  • Modifiers P3 (A patient with severe systemic disease)and P4 (A patient with severe systemic disease that is a constant threat to life) “indicate a moderate to constant threat to a patient’s life when undergoing surgery,” Johnson says.
  • Modifier P5 (A moribund patient who is not expected to survive without the operation) is for patients that are “pretty sickly,” Johnson says. “The surgery could go one way, life, or another, death, but without the surgery, the patient will surely die.”
  • Modifier P6 (A declared brain-dead patient whose organs are being removed for donor purposes)“indicates a patient who is brain dead but the body is still alive,” explains Johnson. You’ll typically use P6 for a patient who is receiving anesthesia to harvest organs before the provider removes life support.

Include P Mods for Every Payer that Requires Them

Though some payers — Medicare included — will not pay anything extra for the P modifiers, payers might require the modifiers to prove medical necessity for anesthesia services in certain situations.

Bonus: Although you should append P modifiers whether they allow additional payment or not, some insurance companies will pay extra for services with a higher designation, says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Best bet: Check your private payer contracts to see how they would like you to report P modifiers, and whether or not higher-level P modifiers result in more payment.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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