The anesthesia modifiers P1 to P6 identify the patient’s health condition to whom the provider will administer the anesthesia. Below are the descriptions and billing guidelines for the anesthesia physical status modifiers.
The identification of the health condition helps the payer to determine the complexity of the anesthesia case. Many payers will reimburse more for anesthesia identified with modifiers P2 to P5 because the patient’s case is likely more complex.
The provider only uses anesthesia physical status modifiers with anesthesia codes ranging from 00100 to 01999. Coders can not append these modifiers; only the anesthesia provider will append them.
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- Modifier P1
- Modifier P2
- Modifier P3
- Modifier P4
- Modifier P5
- Modifier P6
1. Modifier P1
The official description of anesthesia physical status modifier P1 is: “A normal healthy patient.”
Modifier P1 can be reported for an anesthesia provider administering anesthesia to a normal healthy individual.
1.2 Billing Guidelines
The anesthesia provider appends the P1 modifier to a general anesthesia code to show that the provider administers anesthesia to a normal healthy individual during any procedure.
A normal healthy individual includes patients with no physiologic or psychiatric disorder and patients with a good level of exercise tolerance. It does not include very young and very old individuals.
Include a medical record to justify that the individual being normal and healthy.
The medical record should
2. Modifier P2
The official description of anesthesia physical status modifier P2 is: “A patient with mild systemic disease.”
Report modifier P2 for an anesthesia provider who provides anesthesia to an individual with mild systemic disease. In other words, a well-controlled disease of one body system.
2.2 Billing Guidelines
The anesthesia provider appends the P2 modifier to an anesthesia code to show that the provider administers anesthesia services to a patient with mild systemic disease.
Patients with a mild systemic disease have a well-controlled disease of one body system.
- controlled diabetes mellitus;
- controlled hypertension;
- mild obesity; or
- a smoking history with no chronic obstructive pulmonary disease symptoms.
The mild systemic illness does not affect the activities of daily living.
A medical record has to be included to prove the mild systemic disease.
3. Modifier P3
The official description of anesthesia physical status modifier P3 is: “A patient with severe systemic disease.”
Modifier P3 can be reported for anesthesia services for patients with severe systemic disease. Anyone with a severe systemic disease is limited in activities and has a well-controlled disease/diseases of one or more (major) body system(s).
3.2 Billing Guidelines
The P3 modifier can only be billed by the anesthesia provider with an anesthesia CPT code to show the severe systemic disease.
Examples of severe systemic disease are;
- poorly controlled hypertension,
- patients with stable angina,
- type 1 diabetes which affects the vascular system,
- controlled congestive heart failure, and
- moderate obesity.
There is no immediate danger of death in severe systemic disease.
Include a diagnosis of the severe systemic disease in the medical record.
4. Modifier P4
The official description of anesthesia physical status modifier P4 is: “A patient with severe systemic disease that is a constant threat to life.”
The P4 Modifier can be billed for anesthesia services provided to patients who are in a life-threatening situation because of a severe systemic disease.
4.2 Billing Guidelines
Report this modifier with the general anesthesia CPT code to prove that the patient is in a life-threatening situation due to a severe systemic disease.
A diagnosis of the severe systemic disease with possible risk of death has to be included in the documentation.
- symptomatic congestive heart failure;
- chronic renal failure, or
- patients with unstable angina.
5. Modifier P5
The official description of anesthesia physical status modifier P5 is: “A moribund patient who is not expected to survive without the operation.”
This modifier can be billed by an anesthesia provider who has provided anesthesia services to a terminally ill patient.
5.2 Billing Guidelines
Report the P5 modifier with the CPT code for a life-saving procedure and a medical record to prove that the patient is injured or critically ill.
6. Modifier P6
The official description of anesthesia physical status modifier P6 is: “A declared brain-dead patient whose organs are being removed for donor purposes.”
The P6 modifier indicates that a anesthesia provider administered anesthesia to a brain-dead patient to remove organs for donation.
6.2 Billing Guidelines
Modifier P6 has to be reported in combination with the anesthesia code, proving that anesthesia is provided to a brain-dead patient to remove organs.
Two doctors, who are not associated with the transplant team, have to determin a patient is brain dead.
Make sure to include a medical record with a diagnosis of the brain-dead patient and that he or she is donating organs.