Order of appearance is important. Modifiers that affect payment should be listed first, followed by modifiers that are solely informational.
Adding modifier 27 to the second and subsequent evaluation and management code signals that there were different encounters with the same patient on the same date. For example, it may be used when a patient is seen in Internal Medicine and Orthopedics on the same date of service for different reasons. This may avoid an unnecessary denial for a claim that appears to be a duplicate. Modifier 27 is used for outpatient visits, and can be combined with other modifiers. Since modifier 27 doesn’t affect payment, it would be sequenced after any payment modifiers, if they are needed.
Surgical procedures that are started but are not completed should have modifier 52 or 53 appended, depending upon the reason that the procedure is stopped.
Both modifiers that signal a discontinued procedure could impact payment and should be listed first if there is more than one modifier used for the discontinued service.
If the work involved in a procedure is considered substantially greater than normally expected, modifier 22 can be added. This may include substantial –
Modifier 22 is considered a payment modifier – however, it’s not a guarantee that payment will be adjusted. Documentation must also accompany the claim to explain the extra work involved.
Many other modifiers (both payment and informational) can be found on the CMS website and within your CPT resource.
As always, proper coding is the key to efficient claims processing and results in a lower incidence of denials.