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multiple modifiers

  1. #1
    Question multiple modifiers
    Medical Coding Books
    Is there a sequencing rule for using multiple modifiers? (more than one). Which modifier should be used first?

  2. #2
    Columbia, MO
    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.

  3. #3
    Default Thank you!
    Was wondering about using an 80 and 59 on the same code.

  4. #4
    Columbia, MO
    You would need to put the assistant surgeon modifier first

  5. #5
    Smile guidelines: order of modifiers
    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


    - 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.

  6. #6
    Thank you, Luz! This is really helpful.

  7. Default
    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?

  8. #8
    No, you will need a separate line for each toe.

  9. #9
    Has anyone seen a 51 and a 26 on the same service?

  10. #10
    Dallas and Richardson, TX
    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.

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