Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?

May 27th, 2019 - Wyn Staheli, Director of Research
Categories:   Chiropractic   Physical Medicine|Physical Therapy   Modifiers  
0 Votes - Sign in to vote or comment.

Question

Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3.

Also, it shows the 59 Modifier listed as 1st. Doesn't Medicare require the use of the X modifier and not 59? Should the XS modifier be used in place of 59?

Answer

The modifiers showing in the DeskBook are not in any particular order because that order can vary depending on the payer. Technically speaking, payment modifiers (e.g., 22, TC) come before informational modifiers (e.g., GP), but the payer's policy is the determining factor as to the order of the modifiers. Some, but not all, payers automatically reorder modifiers when a claim is submitted. Many billing experts agree that the order of these particular modifiers DOES NOT MATTER.

As for modifier XS, some payers want to see the X{ESPU} instead of modifier 59 (if applicable). However, this again goes back to the specific requirements of the payer. We do recommend using the appropriate X{ESPU} instead of the 59, but if you have a claim rejected, you'll need to use modifier 59 when you resubmit the claim.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
E-Health is a Big Deal in 2020
September 16th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
Chiropractic 2020 Codes Changes Are Here
September 9th, 2019 - Wyn Staheli, Director of Research
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association