Wiki Billing modifier 59 on 36415

kathleeng

Guru
Messages
140
Location
Fresno, CA
Best answers
0
Is it appropriate use of modifier 59 to attach it to 36415 when billing the lab cpt codes in our lab? Blue Shield stated it can be used to unbundle these but from my research, 36415 should not be billed in these cases. Is anyone familiar with this situation?
 
I don't feel like we have enough information to answer. Can you provide more information about the type of office you are in, other services being billed, etc?
 
My apologies. I work for a oncology/hematology office and we have our own lab which I do coding for also. We bill under our lab POS for the lab tests ran with 36415, but we recently have been receiving denials for lab cpt code 84153 being billed with the 36415. Blue Shield states we can use modifier 59 to get the 36415 paid, but I'm not sure that is appropriate. It seems to me, maybe we should not bill for the 36415 at all, in these cases.
 
No worries. I'm in a hem/onc office too and we used to do our own lab billing (outsourced now, thank goodness!) There is no CCI relationship between 84153 and 36415 so I would only use the 59 modifier if another draw was done the same day. Our local Anthem (BCBS) was notorious for bundling our draws with services done by other physicians and we would have to use a 59 modifier on those (the XP modifier would have been very useful to have then). You have no other service - visit, radiology or drug admin - billed on the same day the 36415 could be bundling with?
 
Top