Friday, July 22, 2016

Usage of Modifer 99

Modifier 99  Multiple Modifiers (same line, same code)

Definition:

• Multiple Modifiers are required on one line of service.

Appropriate Usage:

• Reportable on all procedure codes
• Report modifier 99 in the first modifier position on the line of service
o list all other modifiers in item 19 or the equivalent electronic data field.
• If the claim has more than one detail line, indicate the detail line number in Item 19 or the equivalent electronic data field.

Inappropriate Usage:

• Reporting three different modifiers in the first three modifier fields and then 99 in the fourth.
• Reporting less than five modifiers for one line of service

When more than four modifiers are needed to describe a service on the same code, replace with modifier 99.

Correct Use

    Reflect all modifiers involved in Item 19 narrative or electronic equivalent

    Replace with modifier 99 in Item 24D
    Documentation must explain all modifiers involved
    Includes informational and pricing modifiers
    Certain modifiers may affect payment

Incorrect Use

    In this situation, do not append other modifiers in Item 24D

Claim Coding Example

Patient had a Mohs removal (within 90 day global) on the left cheek and then another on the right cheek (RT) by the same provider, repeated twice (i.e., 79, 59, RT) and not enough modifier spaces.

Treatment Description


CPT/Modifier

Mohs micrographic technique, including removal


17311 99

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