multiple modifiers

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

:)
 
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?
 
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.
 
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
 
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
 
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:
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
 
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.
 
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....
 
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
 
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!
 
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.

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

:)
 
Hello Everyone. :)

This post has been very helpful and very much appreciated! This may be a silly question, but would someone please expand upon the hierarchy of modifiers of the same category? For instance, if two pricing modifiers are used together or two payment modifiers, what factors determine which one goes first? Is this found in a resource or is it a matter of researching each insurance and a bit of trial and error? As always, I appreciate your help!

Thank you in Advance,
Kim
 
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