Which modifier goes first, 54 or 79?
Asked by: Burnice Bartell | Last update: February 16, 2025Score: 4.6/5 (32 votes)
What is the correct order for modifiers?
In medical coding, modifiers are used to give additional information about a procedure, service, or supply, and modifiers that will have the biggest impact on reimbursement are normally sequenced first. These modifiers typically fall into one of three categories: (1) Pricing, (2) Payment, or (3) Location.
When should modifier 79 be applied?
Instructions: This modifier is used when an unrelated procedure or service, by the same physician, is performed during the postoperative period (10- or 90-day global) of the original procedure.
When should modifier 54 be used?
The provider who performed surgical care should append modifier 54 to the appropriate CPT® code(s) to describe the surgery performed. Per CMS, the modifier signals that the surgeon intends to transfer “all or part of the post-operative care” to another provider.
Which modifier goes first 78 or 59?
If you have two pricing modifiers, the most common scenario is likely to involve 26 and another modifier. Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position. If 51 and 78, enter 78 in the first position.
Difference between 78, 79 and 58 modifier in medical coding
What is the difference between modifier 59 and 79?
While for some this modifier might cause confusion, it's pretty simple to differentiate it from the other ones. Modifier 59 refers to a non-E/M service performed on the same day. In comparison, modifiers 79, 78, and 58 refer to unrelated procedures or E/M services performed post-op.
What is a 78 modifier used for?
Modifier 78 is used to report the unplanned return to the operating/procedure room by the same physician following an initial procedure for a related procedure during the postoperative period.
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is the 54 billing modifier?
Modifier -54 (Surgical Care Only) is used by the surgeon, appended to the CPT code for the surgical procedure; to indicate they performed only the surgical portion of the procedure and a formal, documented (written) transfer of care was executed.
What is a 58 modifier used for?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
Which type of modifier should be listed first if applicable?
Pricing Modifiers
A pricing modifier is a medical coding modifier that causes a pricing change for the code reported. The Multi-Carrier System (MCS) that Medicare uses for claims processing requires pricing modifiers to be in the first modifier position, before any informational modifiers.
What is the proper use of modifier 57?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
How is modifier placed correctly?
Typically, modifiers are placed right beside the noun they're modifying. Usually, this means right before or after the noun: My calico cat is always by my side.
When to use modifier 79?
Modifier 79 is used to indicate an unrelated procedure that was performed by the same physician or other qualified health care professional during the post-operative period.
Does order of modifiers matter?
Answer: Yes. The payment modifier should be placed first and then any informational modifiers follow. A payment modifier example is -58, -79. These modifiers tell the payer why a surgery should be paid a certain way.
When to use modifier 54?
The provider who performed surgical care should append modifier 54 to the appropriate CPT® code(s) to describe the surgery performed. The modifier signals that the surgeon intends to relinquish “all or part of the post-operative care” to another provider, per CMS.
Does 51 or 59 modifier go first?
There is no real need to use both - EVER. Doing so is unnecessary. The -59 modifier tells you that this is a distinct procedure from the first procedure (for example two distinct lesions). The -51 modifier would tell you that you performed a second (or third or fourth...)
What is the modifier 52 rule?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Does modifier 59 go on primary or secondary?
It should only be used if no other modifier more appropriately describes the relationship of the two or more procedure codes.” This is different from the way CPT defines modifier 59. In other words, a physician can use modifier 59 to bill the secondary, additional, or lesser procedure in an NCCI edit combination.
How are multiple modifiers sequenced?
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario.
What is modifier 80?
Current Procedural Terminology (CPT®) Modifier 80 - CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon.
What is 58 modifier?
Defining Modifier 58
To start, modifier 58 is a surgical-specific modifier, used to indicate a staged or related procedure or service by the same physician during the postoperative period.
What is modifier 59 used for?
For the NCCI, the primary purpose of CPT® modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.
What is modifier 73?
Use modifier 73 to report discontinued outpatient/hospital ambulatory surgical center (ASC) procedure prior to the administration of anesthesia. Physicians should not use this modifier. This is only appropriate for use by the ASC.