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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

CEU Modifiers on Demand Class

AAPC – Proper Modifier Sequencing

sequencing modifiers

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2016-11-20T23:37:26+00:00

About the Author:

JoAnne Sheehan
JoAnne Sheehan has been successfully providing medical billing, coding and practice management services in the New England area for over thirty-three years. She has witnessed the evolution of healthcare and the increased complexities of medical billing and coding regulations, creating a need for education in this field. JoAnne has been featured in numerous medical publications and has acted as a medical billing expert in highly profiled Medicare and Medicaid fraud cases in Boston and has trained others on both a local and national level in medical billing and coding. She is a certified medical coding instructor, practice management consultant, and an AAPC approved ICD-10-CM instructor. Her hands-on experience is an asset for the CCO students she coaches. She is President and Founder of Lomar Associates, Inc., a practice management company established in 1981.

2 Comments

  1. Laureen
    Laureen January 22, 2015 at 9:06 am - Reply

    Nice blog post JoAnne – thanks for sharing!

  2. Alicia January 22, 2015 at 11:13 am - Reply

    Fantastic! I really wish I had this article for my students to reference when I was teaching at the college. You explained it better then I ever did.

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