Wiki 82784 - Immunoglobulin - Help!

[Sdrivera]

Hi! I'm needing some assistance/guidance in how to properly bill 82784. I saw a previous forum post from 2015 with this answer:

You definitely can bill that CPT for each test ordered, and most payers will want the quantity bundled on a single line with no modifier necessary (no line 19 description should be necessary as they're already assigned to the CPT selected).

If on separate lines on the claim, the 59 or 91 modifier (depending on payer interpretation) would be required on lines 2,3 & 4.

Are these guidelines current today when billing 82784?

We have a provider who billed it as such to Medicare:
Line item 1: 82784 - 1 unit
Line item 2: 82784-91 - 1 unit
Line item 3: 82784-91 - 3 units

The first time the claim went out there were no modifiers and only line item 1 was paid. It then went out as a corrected claim with the modifiers and then line item 2 was paid. My assumption after researching is that 82784 is only allowed up to 4 units billed because there are only 4 immunoglobulins in the code description (IgA, IgD, IgG, IgM).

I am unable to locate specific guidelines/policies to correctly bill this code to Medicare. I was only able to locate the Medicare Claims Processing Manual: Chapter 16 - Laboratory Services.

Thanks in advance!

 

[danachock]

Hello Sdrivera,
82784 may be billed 6 times before exceeding the MUE.
I'm shaking my head here. Why are the quantities misaligned? I read your IgA, IgD, IgG, IgM and saw your example that a total of 5 quantities were billed! First, one unit. second, one unit, and third, three units.
Who or why would they apply modifier 91 is my next question? Modifier 91 is so incredibly rare in the laboratory world (unless it's payer specific) and I would not ever use that unless absolutely appropriate.
Modifier 91 is a "Repeat Clinical Diagnostic Laboratory Test".
Where was modifier 91 applicable? In my opinion It never was.
Let's review the CPT book next together: 82784 states Gammaglobulin (immunoglobulin) from your post IGA, IgD, IgG, IgM, each.
Is it simply possible the CPT book isn't current stating IgE?
I'm not one to be crabby but the ICD world and CPT world really needs to align themselves better when publishing these books.
I'm just clearly baffled someone would send seriously Medicare a modifier 91 when they (Medicare) went out of their way a few years ago to give us XS, XE, XP, XU.
Best,
Dana