Cracking the Code

Sequencing of Modifiers

When assigning modifiers to respective CPT codes, medical coders must understand the importance of proper sequencing. There are guidelines in place that state exactly the order in which modifiers should be assigned. 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. Modifiers 26 and TC are examples of pricing modifiers while modifiers 51 and 59 are examples of payment. RT and LT are examples of location modifiers. Claims are often denied due to improper use of modifiers. Understanding this on the front-end with medical coders will assist with preventing issues with medical claims on the back-end with the billing department.

Modifier 26 indicates that the physician ONLY performed the professional component of the service. Modifier RT indicates that the x-ray was completed on the right elbow. This is also proper sequencing with the pricing modifier reported before the location modifier.

Q: A 40-year-old female patient presents to the ED with right elbow pain. Physician orders an x-ray. The radiologist provides an interpretation of the x-ray, stating the results are negative for dislocation or fracture. The physician wants to ensure this is billed correctly with proper modifier assignment.
A: CPT 73070-26-RT
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