63 Modifier

LisaLMay

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When a surgeon performs a surgery on an infant less than 4 kg, I add the 63 modifier. Because of the added complexity due to the infants size, it's appropriate to increase the fee. Is this normal procedure for all of you that are coding these procedures ?
Thank you,
Lisa May, CPC
 
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Milwaukee WI
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Increase fee with 63 modifier

Yes, we use the 63 modifier when infant's weight is documented in the op report AND the procedure allows this modifier. Some procedures which are intended to be performed on an infant do not allow this modifier.

We also increase our fee when using the 63 modifier. Be sure to watch your reimbursement carefully. Many payors ignore the increased fee and modifier and just pay as per usual. So you may have to appeal with copies of the medical record to show justification for increased fee.

F Tessa Bartels CPC
 
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