Proper Reporting of Modifier 99.
Modifier 99 Multiple modifiers do not get a lot of attention as it is rarely needed , but knowing when to apply it can make the difference in getting a claim paid.
Appendix A ? Modifiers tells us:
Under certain circumstances, 2 or more modifiers may be necessary to completely delineate a service. In such situations, modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service.
In practice, call on modifier 99 only if a single line item requires five or more modifiers. The reason is the standard 1500 Health Insurance Claim Form (or electronic equivalent) field 24D accommodates the entry of up to four modifiers:
If a single line item requires more than four modifiers, enter modifier 99 (and only modifier 99) in the first space available for modifiers in field 24D. All other applicable modifiers should be entered in field 19 ?Additional Claim Information,? or the equivalent electronic data field. You may use modifier 99, when applicable, with any CPT(R) code.
Medicare Carriers Manual Part 4 ? Professional Relations, Transmittal 25, Change Request (CR) 1910 (Nov. 1, 2001) further specifies, ?If modifier -99 is entered on multiple line items of a single claim form, all applicable modifiers for each line item containing a -99 modifier should be listed as follows: 1=(mod), where the number 1 represents the line item and ?mod? represents all modifiers applicable to the referenced line item.?
Sequencing Modifiers:
When listing multiple modifiers for the same line item, take care to sequence the modifiers affecting payment first. Level I payment modifiers include:
- 26Professional component
- 50Bilateral procedure
- 53Discontinued procedure
- 54Surgical care only
- 55Postoperative management only
- 56Preoperative management only
- 62Two surgeons66 Surgical team
- 78Unplanned return to operating/procedure room by the same physician or other qualified healthcare professional following an initial procedure for a related procedure during postoperative period
- 80Assistant surgeon
- 81Minimum assistant surgeon
- 82Assistant surgeon (when qualified resident surgeon not available)
- 91Repeat clinical diagnostic laboratory test
Informational or statistical modifiers (any modifier not classified as a payment modifier) are sequenced after payment modifiers. If multiple informational/statistical modifiers apply, you may sequence them in any order (as long as they are sequenced after any payment modifiers).