Optometry Coding & Billing Alert

Question: When I append multiple modifiers to a CPT code, is there any rule about the order in which they should appear?

Pennsylvania Subscriber

Answer: If you are reporting a code that is bundled into another procedure by the National Correct Coding Initiative (NCCI), you should first list any modifiers that justify reporting the two procedures together -- modifiers like 59 (Distinct procedural service) that show that the procedure was necessary and distinct from the other service.

Next: List any modifiers that affect payment -- such as 50 (Bilateral procedure) or 51 (Multiple services).

Then: List any "informational" modifiers -- such as RT (Right side) or LT (Left side) -- that will not affect the reimbursement for the CPT code but provide more specific information such as what side the optometrist performed the procedure on.

Listing informational modifiers before payment modifiers may lead to denials.

-- Answers to You Be the Expert and Reader Questions reviewed by David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas.