There is always the risk of adverse reaction when a patient needs anesthesia. The P (physical status) modifiers indicate the patient’s physical status pre-anesthesia, which paints a better picture of the overall encounter. The modifiers are as follows:
- Modifier P1 (A normal healthy patient) Healthy, non-smoking, no or minimal alcohol use. Most children and some patients under 30 years would fall into this category.
- Modifier P2 (A patient with mild systemic disease) Mild diseases only. Examples include (but not limited to) current smoker, social alcohol drinker, pregnancy, Obesity (BMI <40), and well controlled DM/HTN.
- Modifier P3 (A patient with severe systemic disease) One or more moderate to severe diseases. Examples include (but not limited to) Poorly controlled DM/HTN, COPD, Morbid Obesity (BMI >40), ESRD with Regular Dialysis, and patients more than 3 months since an MI, CVA, TIA or CAD/Stents.
- Modifier P4 (A patient with severe systemic disease that is a constant threat to life) indicate a moderate to constant threat to a patient’s life when undergoing surgery. Examples include (but not limited to) Recent (<3 month) MI, CVA, TIA or CAD/Stents, Valve disfunction, DIC, ARD, or ESRD without dialysis.
- Modifier P5 (A moribund patient who is not expected to survive without the operation) The surgery could be lifesaving or life threatening, but without the surgery, the patient will surely die. Examples included (but not limited to) Ruptured Abdominal or Thoracic aneurysm, massive trauma, intracranial bleed with mass effect, or multiple organ/system dysfunction.
- Modifier P6 (A declared brain-dead patient whose organs are being removed for donor purposes) indicates a patient who is brain-dead but the body is still alive. You’ll typically use P6 for a patient who is receiving anesthesia to harvest organs before the provider removes life support.
Though some payers — including traditional Medicare — will not pay anything extra for P modifiers, payers might require the modifiers to prove medical necessity for other anesthesia services in certain situations. The patient’s physical status must be documented in the patient’s medical record, regardless of whether you’ll be reimbursed for it.