Using multiple modifiers that reduce payment (52 & 78)

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Using multiple modifiers that reduce payment (52 & 78)

Postby Clark » Thu Jan 18, 2018 11:45 pm

When using multiple modifiers that reduce payment (78 and 52), which should be the primary modifier.

Example: Patient has a right hip replacement and two weeks later the patient has an unplanned, uncomplicated right hip revision (due to complication). The provider would like to use the modifier 52 to reduce the revision, since it was uncomplicated.

I have not been able to fine any resource to guide available.
Last edited by Clark on Wed Jan 24, 2018 9:49 pm, edited 2 times in total.
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Re: Using multiple modifiers that reduce payment (52 & 78)

Postby admin » Mon Jan 22, 2018 6:48 pm

Hello, Per Noridian, here is guidance on ordering modifiers:

https://med.noridianmedicare.com/web/je ... /modifiers

Guidelines: order of modifiers
CATEGORIES:
1. PRICING modifiers (eg.,21, 22, 26, 50, 52, 53, 60, 62, 80, 82, P1-P6)

2. PAYMENT Eligible Modifier* (eg. 24, 25, 51, 57, 58, 59, 76, 77, 78, 79, 91)
(*presence communicates special situation that might otherwise not be paid
without the modifier based on billing/coding principles and global surgery guidelines)

3. LOCATION Modifiers E1-E4, FA, F1-F9, LC, LD, LT, RC, RT, TA, T1-T9

ORDER OF REPORTING:

- Pricing modifiers before payment modifiers and location modifiers EXCEPT when global surgery package involved, then report payment modifiers before pricing. Example modifier 78 and 62.
- Payment eligible modifiers before location modifiers
- Location modifiers are always last

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.

Your question has been answered by Sean Weiss, CHC, CMCO, CEMA, CPMA, CMPE, CPC-P, CPC
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