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Multiple Modifiers

When listing multiple modifiers for the same line item, take care to sequence those modifiers that affect payment first. Level I payment modifiers include:

26 Professional component
50 Bilateral procedure
53 Discontinued procedure
54 Surgical care only
55 Postoperative management only
56 Preoperative management only
62 Two surgeons
66 Surgical team
78 Unplanned return to operating/procedure room by the same physician or other qualified healthcare professional following an initial procedure for a related procedure during postoperative period
80 Assistant surgeon
81 Minimum assistant surgeon
82 Assistant surgeon (when qualified resident surgeon not available)
91 Repeat clinical diagnostic laboratory test

Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) are sequenced after payment modifiers, if multiple modifiers apply. If multiple informational/statistical modifiers apply, you may sequence them in any order (as long as they are sequenced after any payment modifiers).

For example, if a procedure defined as unilateral is performed on both sides of the body, modifier 50 would apply. As well, the same physician performs the procedure during the global period of an unrelated, previous procedure; therefore, modifier 79 Unrelated procedure or service by the same physician during the postoperative period is also appropriate. Because modifier 50 is a payment modifier, it would be sequence first and modifier 79 (an informational modifier) would be sequenced after it.

CPT® Appendix A—Modifiers tells us:

Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. In such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service.

In practice, you will call on modifier 99 only if a single line item requires five or more modifiers. The reason is, the standard 1500 Health Insurance Claim Form (or electronic equivalent) field 24D accommodates the entry of up to four modifiers.

If a single line item requires more than four modifiers, you should enter modifier 99 (and only modifier 99) in the first space available for modifiers in field 24D. All other applicable modifiers should be entered in field 19 “Additional Claim Information,” or the equivalent electronic data field. You may use modifier 99, when applicable, with any CPT® code.

Medicare Carriers Manual Part 4 - Professional Relations, Transmittal 25, Change Request 1910 (Nov. 1, 2001) further specifies, “If modifier -99 is entered on multiple line items of a single claim form, all applicable modifiers for each line item containing a -99 modifier should be listed as follows: 1=(mod), where the number 1 represents the line item and “mod” represents all modifiers applicable to the referenced line item.”

dlk

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Is there a sequencing rule for using multiple modifiers? (more than one). Which modifier should be used first?
 

mitchellde

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You always put the one first which will modify or adjust the reimbursement the most... a 59 will signal that this is a separate line item and is not bundled, an Rt or LT says this was performed on the right or left side. I hope this helps.. give me your scenario and I can help more.
 
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guidelines: order of modifiers

CATEGORIES:
1. PRICING modifiers (eg.,21, 22, 26, 50, 52, 53, 60, 62, 80, 82, P1-P6)

2. PAYMENT Eligible Modifier* (eg. 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 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.

:)
 
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Can you use modifier 59 with T1, T2 (all on one line) or should you separate as
59, T1 and then second line to reflect 59,T2, or are they both correct?
 

Kseghel

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Yes I have seen 59 and 26 modifiers together. I work for a cardiology practice and when we do Left Heart Catherizations and Stents on the same day, we use the following modifiers in the following order: 26,59,51. That is telling the payer that there are multiple procedures done on the same patient at the same time. Hope it's helpful.
 

Nicosia

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Busy Coder

Does anyone know why Medicare isnt paying stents and caths done during the same encounter? I always apply modifier 26/59, but its not paying.
:rolleyes:
thanks...BXN
 

ollielooya

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This topic of multiple modifiers brings up another thought. When more than two modifiers are needed, how appropriate is it to use modifier 99? From what I've studied this modifier may be a carrier preference and halts the processing of the claim and reverts to manual review. And if so, how would it's application be beneficial to the questions submitted on this thread? ---Suzanne E. Byrum CPC
 

RonMcK3

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99 w/ multiple modifiers

When more than two modifiers are needed, how appropriate is it to use modifier 99?
As I recall, you only use 99 when there are more than 4 modifiers on a procedure. The CMS-1500 procedure line has spaces for 4 modifiers but when there are more you enter 99 on your first line and then add additional lines to pick up all the appropriate modifiers.
 
Last edited:

ollielooya

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Hi, Ron, and thanks for your input, but I do not ever remember being instructed that more than 4 modifiers would require the use of 99 and I found this in Ingenix 2010 Understanding Modifiers. It suggests that 2 or more modifiers may be necessary to completely delineate a service and that mod. 99 should be added on to the basic procedure, and depending on whether or not the 3rd party computer system accepts multiple modifiers on the same line that it would not be needed. And since there are 4 spaces for modifiers...I suspect you probably were addressing this? I would think additional information could be submitted on line 19 of the HCFA form. Don't know if this spin-off thread should assigned to a "new post", but I find this topic very interesting. ---Suzanne
 

RonMcK3

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Hi, Suzanne,

My reference to a max of 4 modifiers probably is specifc to manually submitted CMS-1500 forms, given that the form (block 24) is limited to a max of 6 procedure lines.
 

kimscoding

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Modifiers 22 & 52

Is there something that states that modifier 22 and 52 can't be coded on the same code? I code GI and some of the procedures are reduced due to the complexity of the procedure. Just wondering....
 

lrwhit2

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How would you report E/M, X-ray & Proc Code

How would report this? E/M, X-ray and Procedure code 20552 on the same dos? Would this be correct?

992XX -25 E/M
70355 Pano
20552 -51 Trigger point Inj; 1 or 2 muscles
 
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additional modifier question

Is there any documentation that shows the order modifiers should be listed in that I can share with my office? ie: pricing, statistical, informational etc.

I have read several forum responses but know one has sited their source? Help please if you know any reference material I can use!

Thanks!
 

blonde01

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Yes. I am not able to upload the document so I copied and pasted it below.

guidelines: order of modifiers
________________________________________
CATEGORIES:
1. PRICING modifiers (eg.,21, 22, 26, 50, 52, 53, 60, 62, 80, 82, P1-P6)

2. PAYMENT Eligible Modifier* (eg. 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 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.

http://www.aapc.com/memberarea/forums/showthread.php?t=17662
 

SusannahR

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Sequencing CPT Modifiers

Hello!

I found this VERY informative post and see it's from 2009; is this information still up-to-date for noting our manuals for 2015 certification exams?

Thank you,
Susannah


CATEGORIES:
1. PRICING modifiers (eg.,21, 22, 26, 50, 52, 53, 60, 62, 80, 82, P1-P6)

2. PAYMENT Eligible Modifier* (eg. 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 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.

:)
 

sidhu123

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I have a question on 59 modifier

Hi,
can we use both xp and xu modifier to the same cpt ?
Please clarify me.
 
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