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:
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?”
9 thoughts on “Tips on Sequencing Modifiers – Improper Use of Modifiers”
Nice blog post JoAnne – thanks for sharing!
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.
How about when there is a staged procedure (78) and there is also an assistant surgeon (mod 80). How are those then sequenced?
Would the GC modifier be sequenced before or after the U9 modifier?
At this time I can not find anything that would indicate sequencing would influcence reimbursement for modifiers, -78, -80, GC or U9.
Can you bill CPT code 85027 with modifier (-26) (TC) together on the same date of service on a claim?
As you can imagine we get quite a few medical coding, billing, auditing and risk adjustment questions on the blog each day. In order to properly allocate resources, we only answer these questions inside the CCO Community forum now. If you’re not a member, you can join for free at https://www.cco.us/cco-free-forum/
I have a question, does Q6 go before 59= Q6.59 or 59.Q6?
In medical coding, the Q6 modifier is always placed before the primary procedure or service code. Therefore, the correct order would be Q6.59. The Q6 modifier indicates that the service was performed by a physician who is not part of the patient’s regular care team. The 59 modifier indicates that a procedure or service is distinct or separate from other procedures or services performed on the same day. When both modifiers apply, the Q6 modifier should be placed first, followed by the 59 modifier.