tci ED Coding & Reimbursement Alert - 2020 Issue Q4

Reader Questions: Sequence Your Modifiers Appropriately

Question: What are the rules governing multiple modifier sequencing? Massachusetts Subscriber 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. Here’s what that means: Pricing modifiers affect the amount of money a payer will pay for a given procedure. For example, modifier 50 (Bilateral procedure), when correctly appended to a unilateral procedure such as 69209 (Removal impacted cerumen using irrigation/ lavage, unilateral), should result in a payment that...

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