If you have been handling coding for your practice for some time now, you must know that modifiers are integral two-digit codes helping you ensure coding specificity. However, what if we say that there is a modifier for multiple modifiers?
Yes, you read it right! We are hinting towards modifier 99. While not always, but sometimes a care service is so complex that it requires more than four modifiers to describe it. When this happens, providers struggle to fill the medical claim form because the standard format allows you to report only four.
If this is something you are dealing with or think you may deal with in the future, continue reading!
Modifier 99 – Description
Modifier 99 indicates to the insurance payer that a specific procedure code needs five or more modifiers to accurately describe it. Thus, you replaced all these modifiers with 99. As a result, they should check the additional claim information section on the medical claim.
A Scenario Where Modifier 99 is Applicable
Let’s review a real-world clinical scenario where this modifier applies:
Emergency Surgery for Pelvic Ring Fracture
Imagine that a 39-year-old male was involved in a high-speed motor vehicle accident, and his injuries included a shattered pelvis and internal hemorrhage. He was immediately taken to an operating room for an emergency surgery. Due to the complexity of his injuries, two surgeons acted as co-surgeons during the surgery (modifier 62). A trauma surgeon managed the patient’s internal bleeding while an orthopedic surgeon reconstructed the pelvis.
However, the procedure took 4 more hours than the average (increased procedural service – modifier 22) because the patient had extensive scarring from a previous surgery and active hemorrhaging. Also, since this was an emergency case, and an anesthesiologist was not readily available, the orthopedic surgeon had to administer regional anesthesia to numb the patient (modifier 47).
Upon the patient’s admission, the surgeons found out that the patient was currently in a 90-day global period for a major hand surgery that was performed two weeks ago. That would make this return to the operating room unrelated to the hand surgery. Hence, modifier 79 would become relevant.
Lastly, since the hospital is located in a federally designated rural shortage area (HPSA), modifier AQ will be applied.
So, that brings the total count of modifiers to 5. However, the claim form only has 4 modifier slots. In this case, the billing team will append modifier 99 to the procedural code 27217.
Modifier 99 – Billing Guidelines
The following are the essential billing guidelines for this modifier:
Know When to Append Modifier 99
Use it when you need five or more modifiers to accurately describe a single CPT or HCPCS code. The reason? The CMS-1500 form and its electronic equivalent only have four physical slots in ‘Item 24D’. Thus, report modifier 99 in the first space available for modifiers in field 24D.
However, you must not forget to report all other applicable modifiers in field 19 “Additional Claim Information,” or the equivalent electronic data field.
Understand When NOT to Use It
Avoid reporting modifier 99 if:
- You need four or fewer modifiers to describe a service.
- The electronic systems (837P format) can handle all modifiers. That is, if your software allows it, report them all and skip modifier 99.
Fulfill Documentation Requirements
You must fulfill the documentation requirements to ensure the timely processing of the medical claim:
- Enter modifier 99 in the first space available for modifiers in field 24D.
- In ‘Item 19’ of the form, clearly identify which line the modifiers belong to if you have multiple services.
For example, line 1: 62, 50, 63, 76, T5.
- The patient’s medical record must justify the clinical necessity for every listed modifier.
Summary
Even though modifier 99 is not a common modifier, understanding when to append it can make all the difference in getting paid. It explains to the insurance payer that you needed more than four modifiers to describe the rendered service. Thus, he should check ‘Item 19’ for full disclosure.
Hopefully, with this guide as your go-to resource, you will have no trouble understanding when to or not to apply this modifier. However, if you still struggle, feel free to outsource medical billing services to MediBillMD.
