Unpublished changes
Surgical CPT & modifier reference
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When should Ohtari use this skill?
Always use
Before any surgical claim is submitted in Athena. The revenue integrity workflow consults this skill on every claim.
How should Ohtari handle this situation?
This skill is the source of truth for modifier requirements that the Revenue integrity workflow checks before claims are submitted.
Required modifiers
- 50 — bilateral procedure (always required when bilateral)
- 51 — multiple procedures, same session
- 59 — distinct procedural service (use sparingly, doc must support)
- RT / LT — laterality, required for unilateral procedures
- 22 — increased procedural service (requires written justification)
- 78 / 79 — return to OR (related / unrelated)
Auto-correctable patterns
Ohtari can auto-add laterality modifiers (RT/LT) when the operative report unambiguously specifies the side. All other corrections route to a biller for approval.
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