Sequencing of modifiers
How can that be if the modifiers used were accurate?
There is an order to reporting modifiers and there are three categories that modifier usage fall under:
1. Pricing
- 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.
- For example, you would code modifier 58 first and modifier 82 second in a global surgery.
- A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 62, 80, and P1-P6.
2. Payment
- Payment modifiers alert the insurance carrier that there is a special situation within the claim
- Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 59, 76, and 78.
3. Location
- Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9.
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.
Additional Information
000 = Endoscopic or minor procedure with related preoperative and postoperative relative value units on the day of the procedure only, included in the fee schedule payment amount
010 = Minor procedure with preoperative relative values on the day of the procedure and postoperative values during a 10-day postoperative period included in the fee schedule amount
090 = Major surgery with a one-day preoperative period and 90-day postoperative period included in the fee schedule payment amount
MMM = Maternity codes. The usual global period does not apply.
XXX = Global concept does not apply
YYY = Palmetto GBA will determine whether the global concept applies and establish a postoperative period, if appropriate
ZZZ = Code is related to another service ("add-on" code) and is always included in the global period of the other service
