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.
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.:
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.