Wiki Modifier Sequencing

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Hya726

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Can someone explain to me how to properly sequence modifiers? More specifically if you have an XS, FY, and LT/RT modifier? From what I have read I know the LT/RT would be listed last. But I am unsure how XS affects pricing and if it would come before or after the FY?
 
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I haven't used FY before, but it appears to be similar to TC from what I can see so it affects pricing so I'd list that first. XS is similar to the usage of 59; it unbundles codes. I'd list that second and then list the laterality last.
 
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I found this out on the web:

MODIFIERS CATEGORIES:
1. PRICING modifiers
Example: 21, 22, 26, 50, 52, 53, 60, 62, 80, 82, P1-P6
...
2. PAYMENT Eligible Modifier*
Example: 24, 25, 51, 57, 58, 59, 76, 77, 78, 79, 91
(*presence communicates special situation that might otherwise not be paid
without the modifier based on billing/coding principles and global surgery guidelines)
...
3. LOCATION Modifiers
Example: E1-E4, FA, F1-F9, LC, LD, LT, RC, RT, TA, T1-T9
...
ORDER OF REPORTING:
- Pricing modifiers before payment modifiers and location modifiers EXCEPT when global surgery package involved, then report payment modifiers before pricing. Example modifier 78 and 62.
- Payment eligible modifiers before location modifiers
- Location modifiers are always last
...
If you have two pricing modifiers, the most common scenario is likely to involve 26 and another modifier. Always add 26 before any other modifier.
...
If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position. If 51 and 78, enter 78 in the first position.


ETA: It looks like the FY is a pricing modifier so, if we follow the instructions above, it would be FY then XS (since XS is just like -59)
 
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Does anyone have a citation as to where this guidance comes from? It's been my understanding that sequencing of modifiers is not a correct coding guideline, but rather a convention many coders have adopted to facilitate correct payment due to the fact that some payers' processing systems will only recognize a certain number of modifiers, or will apply payment additions or reductions in a certain order. I don't believe there is actually a 'correct' or 'incorrect' way to sequence modifiera.

In my opinion, for what it's worth, it is necessary to review and consider ALL modifiers in order to determine correct payment, and the payer's responsibility to do so (and most payers these days recognize this fact), so it does not fall to the coder to sequence modifiers in a particular order, although doing so may help to prevent some denials and payment errors.
 
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