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What are the correct modifiers for code 14020 in medical coding? A comprehensive guide by top experts

As a seasoned medical coder, I'm always seeking ways to ensure accurate and efficient coding practices. It's crucial to stay up-to-date with the latest CPT® codes and modifiers, understanding their specific applications. The American Medical Association (AMA) owns the proprietary CPT® codes, and every medical coder needs a license from AMA for utilizing these codes in their practice. Always use the latest codes published by AMA and remember the legal consequences of violating the AMA copyright, and failing to use updated CPT® codes for your medical coding work.

Today, we will dive into the nuances of modifiers for CPT® code 14020: Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 SQ CM or less. This code describes a specific surgical procedure, but its application may vary depending on the context of the surgery.

Modifier 22: Increased Procedural Services

Scenario: Imagine a patient who presents with a complex, deep wound requiring extensive surgical intervention for adjacent tissue transfer.

Question: Should you consider using a modifier to reflect the increased complexity of the surgery for CPT® code 14020?

Answer: Yes, in this scenario, using Modifier 22 - "Increased Procedural Services" is appropriate. This modifier indicates that the physician performed a more extensive service than that ordinarily included in the description of the code.

Example of Communication: "The patient presented with a complex 10 cm2 wound requiring significant undermining and meticulous reconstruction using adjacent tissue transfer. We utilized a flap rotation technique for successful closure."

Medical coding implications: By applying Modifier 22 to code 14020, you accurately convey the extra effort and complexity of the surgery, ensuring appropriate reimbursement for the provider's work.

Modifier 51: Multiple Procedures

Scenario: Consider a patient requiring both an adjacent tissue transfer to a scalp wound and a simple wound repair on an arm, both within the same encounter.

Question: Do you need a modifier to bill for both the adjacent tissue transfer and the separate wound repair procedures?

Answer: Yes! Modifier 51 - "Multiple Procedures" would be utilized here. It is used to indicate that a multiple procedure has been performed.

Example of Communication: "The patient received adjacent tissue transfer to repair a 10 cm2 scalp wound. Additionally, the provider closed a 2 CM laceration on the patient’s right arm."

Medical coding implications: Applying Modifier 51 to code 14020 would allow for accurate billing of both procedures performed during the same encounter.

Modifier 52: Reduced Services

Scenario: Imagine a patient presents with a 10 cm2 wound requiring adjacent tissue transfer. However, due to the patient's medical condition, the physician could only perform a partial reconstruction.

Question: Is a modifier needed to communicate the reduced level of service in this situation?

Answer: Modifier 52 - "Reduced Services" should be utilized. It communicates that the service performed is not entirely complete.

Example of Communication: "The patient, having a pre-existing condition, received partial adjacent tissue transfer due to a complication. The physician only repaired half the initial 10 cm2 defect before ending the procedure."

Medical coding implications: Using Modifier 52 with CPT® code 14020 in this case accurately reflects the reduced level of service performed and may lead to lower reimbursements, but provides transparency in the coding practices.

Modifier 53: Discontinued Procedure

Scenario: A patient needs adjacent tissue transfer for a 10 cm2 scalp wound but is suddenly experiencing severe medical distress during surgery. The physician has to halt the procedure immediately.

Question: How do you document a procedure that was interrupted?

Answer: Modifier 53 - "Discontinued Procedure" is appropriate to indicate a procedure was not completed due to medical reasons.

Example of Communication: "Adjacent tissue transfer was initiated, but the procedure was halted at 50% completion when the patient had sudden severe medical distress. The patient was then stabilized and monitored closely."

Medical coding implications: Utilizing Modifier 53 alongside code 14020 clearly reflects the discontinued procedure and helps in the correct billing, considering only the services completed.

Modifier 54: Surgical Care Only

Scenario: Consider a patient who comes in for a planned 10 cm2 scalp wound reconstruction using adjacent tissue transfer. The surgeon handles the entire surgical procedure while another physician manages the postoperative care.

Question: Does the coding process need to highlight this division of labor between two physicians?

Answer: Yes! Modifier 54 - "Surgical Care Only" should be applied. It distinguishes when the surgeon performed surgical care without the post-operative care.

Example of Communication: "The surgical procedure for the 10 cm2 wound reconstruction on the patient's scalp was carried out by the primary surgeon, followed by post-operative management from another physician specializing in wound care.

Medical coding implications: The application of Modifier 54 accurately reflects the separate services, allowing for accurate billing of the surgical portion and the post-operative management separately.

Modifier 55: Postoperative Management Only

Scenario: The same patient with the scalp wound comes in for their post-operative check-up. The physician, different from the initial surgeon, performs a detailed review of the patient’s healing process, assesses progress, and modifies care as needed.

Question: How to reflect the post-operative service delivered by the physician?

Answer: Modifier 55 - "Postoperative Management Only" will be applied to code 14020 to communicate that only post-operative management occurred.

Example of Communication: "The patient presented for a post-operative assessment of a 10 cm2 scalp wound following an adjacent tissue transfer procedure. During the evaluation, the physician examined the site, assessed healing, and provided ongoing care recommendations."

Medical coding implications: Using Modifier 55 ensures that the physician providing post-operative care is reimbursed correctly.

Modifier 56: Preoperative Management Only

Scenario: Imagine the same patient needs adjacent tissue transfer but is being managed by another physician, who conducted a comprehensive pre-operative evaluation, assessing medical history and risk factors to determine suitability for the procedure.

Question: How to represent the physician’s involvement in the pre-operative assessment phase?

Answer: Modifier 56 - "Preoperative Management Only" is employed in this scenario.

Example of Communication: "The physician conducted a detailed pre-operative assessment, including a review of the patient's medical history, previous surgeries, and allergies to determine suitability for a planned adjacent tissue transfer of a 10 cm2 scalp wound. This assessment ensured adequate preparation for the surgery."

Medical coding implications: The use of Modifier 56 in conjunction with code 14020 allows proper billing of the pre-operative management service.

Modifier 58: Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

Scenario: After a 10 cm2 adjacent tissue transfer for a scalp wound, a patient experiences delayed healing in a localized region, leading to a second procedure by the original surgeon to revise the repaired area.

Question: How to code a staged procedure that happened during the post-operative period?

Answer: Modifier 58 - "Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period" helps convey a procedure is staged.

Example of Communication: "A post-operative check-up for the patient with the scalp wound identified a localized area of delayed healing. This area needed revision, necessitating a second procedure to ensure the successful healing process. The surgeon conducted a second, related procedure to improve wound closure. The staged procedures were crucial for facilitating optimal healing of the 10 cm2 wound."

Medical coding implications: This modifier ensures that staged procedures in the post-operative period are coded appropriately.

Modifier 59: Distinct Procedural Service

Scenario: In a single encounter, a patient with a 10 cm2 wound on the leg receives an adjacent tissue transfer for the leg wound, and also, separately, the surgeon addresses another independent issue on the patient's back (e.g., a small cyst removal).

Question: Should a modifier be used to illustrate that these two procedures are independent and distinct?

Answer: Modifier 59 - "Distinct Procedural Service" is used in this situation to show two unrelated procedures occurred.

Example of Communication: "The patient underwent an adjacent tissue transfer on the leg wound measuring 10 cm2. In addition to the wound closure on the leg, the provider also addressed a separate issue of a small cyst on the patient's back. The two procedures were completely distinct."

Medical coding implications: This modifier ensures correct billing and prevents confusion in payment processing for the separate and independent procedures.

Modifier 73: Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia

Scenario: A patient scheduled for an adjacent tissue transfer for a 10 cm2 scalp wound is preparing for surgery. Anesthesia has not yet been administered, but a change in the patient's condition (e.g., a pre-existing medical issue suddenly exacerbates) necessitates a complete cancellation of the procedure.

Question: How should this interrupted procedure, canceled prior to anesthesia, be documented in the medical coding?

Answer: Modifier 73 - "Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia" should be applied.

Example of Communication: "The patient, who was scheduled for a 10 cm2 adjacent tissue transfer to repair a scalp wound, had a sudden worsening of their pre-existing condition. Therefore, the procedure was canceled prior to anesthesia administration."

Medical coding implications: Modifier 73 accurately reflects the discontinued procedure due to medical circumstances and is used specifically for procedures cancelled prior to anesthesia, preventing overbilling and ensuring proper documentation.

Modifier 74: Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia

Scenario: Similar to the previous case, a patient scheduled for an adjacent tissue transfer is about to receive anesthesia, but their medical condition suddenly becomes a significant risk for surgery, resulting in immediate cancellation of the procedure.

Question: If the procedure was discontinued after anesthesia, what modifier should be used for coding?

Answer: Modifier 74 - "Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia" should be applied when the procedure was canceled post-anesthesia.

Example of Communication: "The patient was receiving general anesthesia in preparation for a 10 cm2 adjacent tissue transfer. However, following anesthesia administration, an unforeseen complication arose, requiring the immediate cessation of the surgery due to the patient's altered medical status. "

Medical coding implications: Modifier 74 is specific to procedure discontinuations after anesthesia, highlighting the significant point at which the surgery was halted and helping to ensure appropriate billing.

Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

Scenario: A patient has already undergone a 10 cm2 adjacent tissue transfer, but due to a delayed healing complication, the original surgeon needs to repeat the procedure within the post-operative period.

Question: What modifier is necessary to indicate a repeat procedure done by the same provider?

Answer: Modifier 76 - "Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional" should be used in such a case.

Example of Communication: "The patient underwent an adjacent tissue transfer of a 10 cm2 scalp wound, but unfortunately, experienced delayed healing, requiring the surgeon to perform a second, repeat procedure to achieve adequate wound closure. "

Medical coding implications: Applying Modifier 76 with code 14020 when billing helps avoid any confusion related to the repeat nature of the service performed and provides clarity for accurate reimbursements.

Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional

Scenario: In the previous example, if the repeat procedure for the 10 cm2 wound was performed not by the original surgeon but by a different, qualified physician in the post-operative period, a different modifier would be necessary.

Question: What modifier applies in a situation where the repeat procedure is done by another, qualified physician?

Answer: Modifier 77 - "Repeat Procedure by Another Physician or Other Qualified Health Care Professional" should be used.

Example of Communication: "The patient had received adjacent tissue transfer on a 10 cm2 scalp wound, but faced complications that necessitated a second procedure by a different surgeon, Dr. Smith, who stepped in to address the delayed healing."

Medical coding implications: Applying Modifier 77 in this scenario allows correct billing and reimbursement for the repeat procedure performed by a different, qualified healthcare professional.

Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

Scenario: A patient received a 10 cm2 adjacent tissue transfer to address a leg wound. During the post-operative recovery, a new complication (e.g., hematoma formation) requires an immediate return to the operating room for corrective action by the original surgeon.

Question: How should the unplanned return to the operating room, within the post-operative period, for a related procedure, be documented?

Answer: Modifier 78 - "Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period" should be applied.

Example of Communication: "Following the initial 10 cm2 adjacent tissue transfer procedure to close the leg wound, the patient presented with hematoma formation. An unplanned return to the operating room was necessary for surgical revision, and this procedure was performed by the original surgeon."

Medical coding implications: Using Modifier 78 provides clarity for the unplanned return to the operating room due to a related post-operative complication, ensuring accurate billing.

Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

Scenario: A patient undergoing an adjacent tissue transfer for a 10 cm2 scalp wound also needs a completely unrelated, unrelated procedure, for instance, the removal of a separate lesion, all performed within the same encounter.

Question: What modifier clarifies the fact that this unrelated procedure is performed within the post-operative period, but distinct from the initial one?

Answer: Modifier 79 - "Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period" is used to denote unrelated procedures done during the same encounter.

Example of Communication: "The patient received a 10 cm2 adjacent tissue transfer for a scalp wound. The physician also addressed a completely unrelated issue, a small benign lesion on the patient’s forearm, during the same encounter. "

Medical coding implications: Modifier 79 indicates the presence of a distinct and unrelated service within the post-operative period. This ensures accurate billing by reflecting the distinct procedure even if performed during the same encounter.

Modifier 99: Multiple Modifiers

Scenario: Imagine the patient in a previous example who required adjacent tissue transfer with a second, related procedure during the post-operative period. Additionally, both procedures involved increased complexity due to the nature of the wound.

Question: How to code a scenario with multiple modifiers, as this situation calls for both Modifier 58 and Modifier 22?

Answer: Modifier 99 - "Multiple Modifiers" is utilized to signify the presence of several modifiers for the same procedure, but is rarely used as specific modifiers usually address the nuances.

Example of Communication: "The patient underwent an adjacent tissue transfer for a 10 cm2 scalp wound. Due to the complex wound healing, a related procedure requiring increased complexity was performed by the same physician within the post-operative period."

Medical coding implications: Modifier 99, when combined with specific modifiers, ensures that the provider's billing accurately reflects all relevant aspects of the services performed.

Modifier LT: Left Side

Scenario: Consider a patient receiving an adjacent tissue transfer to the left arm.

Question: Does the medical coding need to distinguish between the left and right side of the body?

Answer: Yes. The side of the body involved in the procedure is important information to accurately reflect where the service was rendered.

Example of Communication: "The surgeon performed an adjacent tissue transfer on a 10 cm2 wound located on the patient's left arm. "

Medical coding implications: Utilizing modifier LT - "Left side" with code 14020 communicates that the procedure was performed on the patient's left arm.

Modifier RT: Right Side

Scenario: Imagine a patient undergoing a procedure to repair a 10 cm2 wound on their right arm using adjacent tissue transfer.

Question: What modifier distinguishes the right side of the body?

Answer: Modifier RT - "Right side" is essential to indicate the site of service.

Example of Communication: "The surgeon completed a 10 cm2 adjacent tissue transfer procedure to address a wound on the patient’s right arm."

Medical coding implications: Applying Modifier RT provides clear documentation of the location of the procedure.

Modifier TA: Left Foot, Great Toe

Scenario: Consider a patient undergoing a procedure on their left great toe to repair a 10 cm2 wound using adjacent tissue transfer.

Question: Does the medical coding need to be more specific when it comes to individual digits?

Answer: Yes. Modifier TA "Left foot, great toe" indicates that the procedure is specifically on the patient's left foot great toe.

Example of Communication: "The physician treated a 10 cm2 wound on the patient's left foot great toe by performing adjacent tissue transfer. "

Medical coding implications: This modifier enhances clarity in medical coding by precisely specifying the affected digit for correct documentation.

Modifier T1: Left Foot, Second Digit

Scenario: The same as with the great toe, but let's say the patient underwent adjacent tissue transfer on the second toe of their left foot for a 10 cm2 wound.

Question: What modifier applies in this case to accurately depict the digit involved?

Answer: Modifier T1 "Left foot, second digit" communicates that the service was done on the second toe of the left foot.

Example of Communication: "The procedure for the adjacent tissue transfer was carried out to repair a 10 cm2 wound located on the second toe of the patient's left foot."

Medical coding implications: This modifier provides more precision by clearly pinpointing the location on the left foot, the second toe.

Modifier T2: Left Foot, Third Digit

Scenario: Similarly to previous cases, but imagine the adjacent tissue transfer for a 10 cm2 wound was conducted on the patient’s third toe of the left foot.

Question: What modifier ensures proper identification of this specific toe?

Answer: Modifier T2 "Left foot, third digit" is applied when the service was done on the patient's third toe of the left foot.

Example of Communication: "The physician completed adjacent tissue transfer for a 10 cm2 wound that was present on the patient's left foot, third digit."

Medical coding implications: The use of Modifier T2 significantly reduces the risk of ambiguity in billing and improves the clarity and accuracy of the codes, ensuring appropriate payments.

Modifier T3: Left Foot, Fourth Digit

Scenario: The procedure for adjacent tissue transfer of a 10 cm2 wound is conducted on the fourth toe of the left foot.

Question: What modifier signifies this particular location?

Answer: Modifier T3 "Left foot, fourth digit" will be used for a procedure performed on the patient’s left foot, fourth toe.

Example of Communication: "The provider performed an adjacent tissue transfer to treat a 10 cm2 wound that was located on the left foot, fourth digit. "

Medical coding implications: Modifier T3 reinforces the importance of precision in identifying the specific toe of the foot, leading to more accurate documentation and appropriate reimbursement for the services rendered.

Modifier T4: Left Foot, Fifth Digit

Scenario: A patient with a 10 cm2 wound on the fifth toe of the left foot requires adjacent tissue transfer.

Question: What modifier clarifies this specific location on the foot?

Answer: Modifier T4 "Left foot, fifth digit" will be used for services rendered on the patient's left foot, fifth toe.

Example of Communication: "The physician performed an adjacent tissue transfer on a 10 cm2 wound that was situated on the left foot, fifth digit. "

Medical coding implications: Using Modifier T4 prevents confusion in medical coding. It promotes clear and unambiguous documentation and allows for appropriate reimbursement.

Modifier T5: Right Foot, Great Toe

Scenario: Let's shift to the right side and consider a 10 cm2 wound on the patient’s great toe that requires adjacent tissue transfer.

Question: What modifier signifies that the procedure took place on the right foot great toe?

Answer: Modifier T5 "Right foot, great toe" applies to services rendered on the patient’s right foot, great toe.

Example of Communication: "The surgeon repaired a 10 cm2 wound that was present on the patient’s right foot, great toe using an adjacent tissue transfer. "

Medical coding implications: The utilization of Modifier T5 significantly improves the precision and clarity in medical coding, minimizing confusion about the precise location of the procedure and ensuring proper reimbursement.

Modifier T6: Right Foot, Second Digit

Scenario: Imagine a patient presenting for an adjacent tissue transfer procedure for a 10 cm2 wound on the second toe of their right foot.

Question: What modifier identifies this specific digit?

Answer: Modifier T6 "Right foot, second digit" should be used to indicate a service was done on the patient’s right foot, second digit.

Example of Communication: "The provider completed an adjacent tissue transfer for a 10 cm2 wound located on the patient's right foot, second toe. "

Medical coding implications: Modifier T6 enhances the detail in medical coding by pinpointing the specific toe. This accuracy is vital to support precise reimbursement and proper medical records.

Modifier T7: Right Foot, Third Digit

Scenario: Imagine a 10 cm2 wound on the third toe of the patient's right foot that necessitates an adjacent tissue transfer procedure.

Question: What modifier helps identify this precise location?

Answer: Modifier T7 "Right foot, third digit" should be applied in this case.

Example of Communication: "The physician completed an adjacent tissue transfer to treat a 10 cm2 wound that was present on the patient's right foot, third digit. "

Medical coding implications: This modifier, by indicating the specific digit of the right foot, increases the precision and accuracy of medical coding, leading to clearer medical records and improved reimbursement.

Modifier T8: Right Foot, Fourth Digit

Scenario: Imagine the patient needs an adjacent tissue transfer for a 10 cm2 wound on the fourth toe of their right foot.

Question: What modifier helps ensure accurate documentation for this specific digit on the right foot?

Answer: Modifier T8 "Right foot, fourth digit" is the proper choice for services rendered on the patient's right foot, fourth digit.

Example of Communication: "The surgeon performed adjacent tissue transfer for a 10 cm2 wound located on the patient’s right foot, fourth toe. "

Medical coding implications: Using Modifier T8 minimizes the potential for billing errors, promotes transparency in the medical records, and contributes to accurate payment for the procedures done.

Modifier T9: Right Foot, Fifth Digit

Scenario: If the patient needed an adjacent tissue transfer for a 10 cm2 wound on the fifth toe of their right foot, which modifier should be applied?

Question: How to accurately code this location using modifiers?

Answer: Modifier T9 "Right foot, fifth digit" should be used.

Example of Communication: "The provider treated a 10 cm2 wound on the patient’s right foot, fifth toe, through the implementation of adjacent tissue transfer. "

Medical coding implications: The application of Modifier T9 supports clear communication in medical coding, contributing to improved clarity in medical records and greater accuracy in payment.

Modifier XE: Separate Encounter

Scenario: Let's shift the focus to encounters, not digits. A patient previously received adjacent tissue transfer for a 10 cm2 wound, and during a separate encounter, the physician provides post-operative care or wound assessment.

Question: How do you code services related to an initial procedure, but performed during a different encounter?

Answer: Modifier XE "Separate Encounter" is applied in this situation.

Example of Communication: "The patient came in for a post-operative follow-up of the 10 cm2 adjacent tissue transfer procedure completed during a previous encounter. The physician examined the wound site and assessed the healing process."

Medical coding implications: This modifier prevents overbilling by making it clear that the post-operative service is delivered during a separate encounter. Modifier XE also allows proper coding for each encounter individually.

Modifier XP: Separate Practitioner

Scenario: During a post-operative visit for the patient with the 10 cm2 wound, a different physician from the original surgeon delivers post-operative care.

Question: What modifier should be used to denote the change in providers?

Answer: Modifier XP "Separate Practitioner" is the correct modifier in this scenario.

Example of Communication: "During the post-operative check-up, the patient saw Dr. Smith, who was not the initial surgeon for the 10 cm2 wound repair, for evaluation and treatment. Dr. Smith monitored the healing process and provided necessary post-operative care recommendations."

Medical coding implications: Modifier XP helps accurately reflect when services are provided by a different provider from the one who initially performed the adjacent tissue transfer.

Modifier XS: Separate Structure

Scenario: Imagine the same patient presents with two unrelated wounds: one 10 cm2 wound on the left arm requiring adjacent tissue transfer and a separate 2 CM wound on the left hand needing simple wound closure.

Question: How to ensure correct coding for procedures on distinct structures in the same encounter?

Answer: Modifier XS "Separate Structure" would be used to distinguish these two procedures.

Example of Communication: "During this encounter, the patient had an adjacent tissue transfer procedure on a 10 cm2 wound on the left arm. The physician also performed a separate wound closure on a 2 CM wound on the patient’s left hand."

Medical coding implications: Modifier XS indicates that separate and unrelated procedures, on different structures, are performed within the same encounter. This ensures clarity in the medical records and helps ensure appropriate billing.

Modifier XU: Unusual Non-Overlapping Service

Scenario: Imagine a 10 cm2 wound that necessitates a particularly complex and atypical adjacent tissue transfer, involving specific techniques and procedures not typically associated with the standard code description.

Question: How to appropriately document the unusual or atypical aspect of the adjacent tissue transfer service?

Answer: Modifier XU - "Unusual Non-Overlapping Service" is used to communicate that a procedure went beyond the usual scope.

Example of Communication: "The surgeon utilized an advanced, modified adjacent tissue transfer technique with flap reconstruction and innovative suture strategies due to the unique nature and complexity of the 10 cm2 wound on the patient’s arm. "

Medical coding implications: Modifier XU ensures that the unique aspects of the service are clearly captured for reimbursement and medical recordkeeping.

This article explores the use cases of various modifiers in relation to CPT® code 14020. However, this is just a simple example. Remember that accurate and ethical coding practices require ongoing education, keeping abreast of all the latest codes published by AMA, and a full understanding of AMA copyright and legal consequences of using these codes without a proper license. The knowledge provided is intended for general information and is not a substitute for professional advice.

Learn how to accurately use CPT® code 14020 with various modifiers. This comprehensive guide explains the use of modifiers like 22, 51, 52, 53, 54, 55, 56, 58, 59, 73, 74, 76, 77, 78, 79, 99, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, XE, XP, XS, and XU in medical coding. Discover how AI and automation can streamline the process and ensure accurate claims!

What are the correct CPT code 14020 modifiers? A complete guide for medical coders.