Modifier 63 Can Be Redundant
Question: Why can’t I append modifier 63 to CPT® code 36450? The patient in question was 3 days old and weighed 3.48 kg. Maryland Subscriber Answer: CPT® code 36450 (Exchange transfusion, blood; newborn) already specifies the patient’s age. Modifier 63 (Procedure performed on infants less than 4 kg) is intended to reflect the significantly increased complexity of a procedure — and, therefore, payment rates — accordingly. Appending modifier 63 may seem like a good idea because it specifies the weight and therefore provides more information and context, but 36430 is already newborn-specific and therefore inherently reflects possible additional complexity. Moreover, coding 36450 with modifier 63 would go against coding guidelines, as the Notes for 36460 prohibit the use of the modifier. AAPC’s Codify Code Notes instruct coders “(Do not report modifier 63 in conjunction with 36450).” Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
