# Sequencing of CPT codes



## goldenamy8@gmail.com (Feb 18, 2016)

I know it has always been an understood rule that your procedure code or office visit goes first and you go be RVU highest to lowest.  I would like to know if there is any documentation stating your office visit E&M should go first.  We have a new EHR system and it pulls the office visit to the middle or bottom of the charge ticket and the EHR assistants are telling us just to bill the claim "as is" and not worry about the office visit being first.  I have never heard of this.  It would be nice to have some feedback.


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## Walker22 (Feb 18, 2016)

I have never heard of this "rule" where the office visit goes first on a claim. Straight RVU order is the accepted standard.


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## thomas7331 (Feb 19, 2016)

There are no sequencing rules that I am aware of for CPT codes.  My experience is that the codes are often re-ordered by the software used by the provider or payer, but the sequence on the claim should not in any way affect the reporting or payment.


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## CodingKing (Feb 19, 2016)

thomas7331 said:


> There are no sequencing rules that I am aware of for CPT codes.  My experience is that the codes are often re-ordered by the software used by the provider or payer, but the sequence on the claim should not in any way affect the reporting or payment.



I was going to mention that earlier but I wasn't just sure if it was the payer I work for or if the experience was the same with other payers. Our system doesn't care what the order is. For instance Multiple surgery. the lowest RVU could be on line 1, misc labs on line 2-5 and the highest RVU surgery on line 6 and it will still append modifier 51 to line 1 as the lower RVU. Doesn't matter where it is on the claim.

I was told in my coding training that its RVU order. In Practice reviewing claims typically the OV is seen on line 1.


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## Walker22 (Feb 19, 2016)

I think the RVU order of highest to lowest is a holdover from the days when claims were processed manually. In this day and age, the order shouldn't matter as most claims are now machine read and processed. Still, it doesn't hurt to put them in RVU order anyway, just in case you run into one of those rare payers that doesn't use a machine to read/process claims.


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## CICIB (Feb 19, 2016)

Per Official CPC Certification Study Guide, Sequencing CPT Codes- "CPT code sequencing is crucial to appropriate claims submission and appropriate reimbursement. When reporting claims with multiple CPT codes, sequence the codes from highest to lowest relative value"


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## 1073358 (Aug 26, 2016)

*What RVU column to use?*

I agree, sequence highest to lowest to be safe. however, which RVU column do you base it on? Work RVU? Transitional?


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## sujaya101 (Aug 26, 2016)

It really doesn't matter. if you have the right modifier attached, it should be fine. Your payer might bundle the procedure, you have to check CCI Edits.


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