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Wiki 86235 to be billed with modifier 59,91 or QW

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rosamagana

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As a diagnostic test lab, we are supposed to bill 86235 8 times for a test. My question is which modifier I should use? I have heard mixed info about using 91,59 or QW.

Can some one please advise, which modifier I can use and why there are different modifiers?

Thanks in advance,
Amer
 
response to 86235 (multiple charges)

Hi rosamagana,
86235 is a procedure that can be representing many different antibodies. If they are different antibodies you would apply modifier 59 for those subsequent/duplicate charges. If it is the same antibody that was tested at two different times on the same DOS, you would apply modifier 91 (for repeat test). The QW is for CLIA waived test. Per my 2018 Current Procedural Coding Expert book from Optum this is not a CLIA waived test.
Thanks,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB
 
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