Cardiology Coding Alert

Question: If we perform an imaging service for an infant, should we append modifier 63?

Indiana Subscriber

Answer: No. The guidelines for modifier 63 (Procedure performed on infants less than 4 kg) in CPT's Appendix A state that "unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20000-69999 code series." So, unless CPT offers a specific instruction to the contrary, you should not append modifier 63 to codes found in the 70000 section.

Bonus tip: If you do report a service that modifier 63 is appropriate for, pay attention to the weight requirement of "less than 4kg," which translates to roughly 8.8 pounds or less.