Commonly Misused Modifiers

In the English language, modifiers describe information such as the who, what, how, why, or where of a situation. In coding, modifiers also describe information. Using a modifier correctly will clarify a situation or service. Often in chiropractic, confusion as to the proper use of modifiers may result in denials and unnecessary time correcting claims that were unjustly denied.

CPT or HCPCS Level II code modifiers may be two letters, two numbers or a combination of the two. Modifiers indicate that a specific circumstance has altered a service or procedure. Although the event has changed, a modifier will not change the definition or the code. Quite frankly, a modifier will aid in communicating the specifics of a particular encounter. This communication will alleviate any question of fraud or abuse by the carrier.

Modifiers can be classified as having different purposes. Some are considered payment modifiers, which directly impact how much you are allowed to collect for the service. Other modifiers are considered informational. They may show why two services, usually bundled together, should be regarded as separately billable.

Examples of information modifiers include the 25 modifier, which explains why an evaluation and management service (examination) has been unbundled from the chiropractic manipulation. Another is the 59 modifier, which describes why the “distinct procedural service” has been unbundled from other services such as therapy and chiropractic manipulation.

There are many modifiers used for various carriers, including Medicare.

See the proper use of some of the most common modifiers for commercial carriers in chiropractic here.

Article written for Dynamic Chiropractic by Mario Fucinari, DC, CPCO, CPPM, CIC
August 1, 2022