Coders often get confused when appropriate sequencing modifiers are applied to procedure code(s) and their claims get denied for the “improper use of modifiers”.
How can that be if the modifiers used were accurate? The answer is simple: There is an order to reporting modifiers and there are three categories that modifier usage fall under:
1. Pricing
2. Payment
3. Location
A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 60, 80, and P1-P6. Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 69, 76, and 78.
Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9.
Tips on Sequencing Modifiers – Improper Use of Modifiers
Pricing modifiers are always sequenced “before” payment modifiers and/or location modifiers. The only exception to this rule is when a global surgery package is involved. In the case of a global surgery, you would report the payment modifiers “before” the pricing modifiers. For example, you would code modifier 58 first and modifier 82 second in a global surgery.
Payment modifiers alert the insurance carrier that there is a special situation within the claim. In other words, if the payment modifier is not used, the claim would deny based on billing and coding principles as well as global surgery guidelines. For example, if you did not add modifier 25, (a significant, separately identifiable evaluation and management service on the same day of a procedure), to an E/M service with a minor surgical procedure such as wart removal (17110), the E/M service would deny.
The general order of sequencing modifiers is (1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”.
If you code two pricing modifiers that include either a professional or technical component (26 or TC), always use the 26 or TC first, followed by the second pricing modifier.
If you have two payment modifiers, for example 51 and 59, enter 59 first and 51 second. If 51 and 78 are the required modifiers, you would enter 78 in the first position.
Sequencing modifiers may appear confusing but in reality, it is not that difficult. Train yourself to assess each coding scenario carefully and you will find that the methodology used is extremely logical in its approach.
Just ask yourself, “What is the most important consideration I need to communicate to the payer in order to be reimbursed?”
Get More Information about Sequencing Modifiers
CPT® Modifiers Made Easy
AAPC – Proper Modifier Sequencing
FAQs
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario. Modifiers 26 and TC are examples of pricing modifiers while modifiers 51 and 59 are examples of payment. RT and LT are examples of location modifiers.
How can the incorrect use of modifiers affect reimbursem*nt of claims? ›
Incorrect usage of modifiers can result in revenue loss for a medical practice. If not used appropriately, faulty codes can lead to claims denials, reduced income for practices and compliance issues too. The coding modifiers are revised annually by payer organizations.
What is the modifiers rule 33? ›
Modifier 33 is used to tell the payer to process the service without a patient due balance, because it was a preventive service with an A or B rating from the USPSTF. Not all commercial patients will have this first-dollar coverage, but many with group health insurance plans will.
Does the order of CPT modifiers matter? ›
Generally speaking, a modifier that affects payment should be listed first, followed by any modifier that is descriptive in nature.
What is the golden rule of modifiers? ›
What modifies what? Here, we have several thes and each modifies the noun to its right. The third step is to apply our rules, remembering the Golden Rule of Modifiers: Modifiers are always attached within the phrase they modify.
How do you use modifiers correctly? ›
A modifier is a word, phrase, or clause that provides description.
- Always place modifiers as close as possible to the words they modify. ...
- A modifier at the beginning of the sentence must modify the subject of the sentence. ...
- Your modifier must modify a word or phrase that is included in your sentence.
The main problem with the misplaced modifier is that the person reading the sentence may misinterpret the meaning. In the sentence above, the phrase in my pajamas has been placed at the end of the sentence, apparently modifying the word elephant rather than in the beginning, where it would modify the subject I.
How do you avoid mistakes with modifiers? ›
Here are things to remember to avoid making these common modifier mistakes when writing. Keep your modifier as close as possible to what they are modifying. Always put the adjective or adverb next to the words they describe. Identify what it is modifying.
How do you avoid modifier errors? ›
Following are fourrules of placement that can correct the majority of modifier problems:
- Simple adjectives precede.
- Adjective phrases and clauses follow.
- Adverbs move around.
- Limiters precede.
These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circ*mstances. Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia.
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
What is the modifier 26 rule? ›
What you need to know. Modifier 26 is defined as the professional component (PC). The PC is outlined as a physician's service, which may include technician supervision, interpretation of results and a written report. Use modifier 26 when a physician interprets but does not perform the test.
When using multiple modifiers in what order are they sequenced? ›
Answer: The basic rule of modifier sequencing is to sequence payment, or level one, modifiers before informational, or level two, modifiers. Additionally, if you have a modifier that affects pricing, that will be sequenced before any payment eligibility modifier.
How are multiple modifiers sequenced? ›
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursem*nt process first.
What is the proper sequence of modifiers when more than one is necessary? ›
guidelines: order of modifiers
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.
What is the order of modifiers for anesthesia? ›
Pricing modifiers (AA, QK, AD, QY, QX and QZ) should be placed in the first modifier field. If QS modifier applies, it must be in the second modifier field. If reporting multiple modifiers, the medical direction modifier should be listed first, followed by any additional modifiers that are needed.
What is the order of modifiers in Java? ›
The four levels of access modifiers in increasing order of restrictions are public, protected, default, and private. An area where access modifiers are used is method overriding. The rule to be followed here is that the overridden method (i.e. declared in a subclass) must not be more restrictive.
How are multiple modifier sequenced? ›
Question: What are the rules governing multiple modifier sequencing? Answer: The basic rule of modifier sequencing is to sequence payment, or level one, modifiers before informational, or level two, modifiers.
What order should codes be sequenced? ›
ICD-10-CM Official Guidelines has a coding convention where certain conditions that have both an underlying etiology and co-morbidities or multiple body system manifestations due to the underlying etiology requires the underlying condition be sequenced first, if applicable, followed by the manifestation.
