Wiki CPT 82043 Modifier 91

[RaeToll]

I have a facility claim for CPT code 82043 for Microalbumin, Urine Random and CPT codes 82043-91 and 82570 for Microalbumin Creatinine Urine Ratio denied by Medicare as "number of units not supported". Both orders were placed at the same time from the same provider.

If anyone has experience with this, can I bill the second CPT 82043 with Modifier -59 or -QP? Or is it just not going to be paid for 2 units?

Modifier -59 Distinct Procedural Service (Hospital OPPS Modifier)

Modifier -QP Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes 80002-80019, G0058, G0059, and G0060

CPT code 82043 for Microalbumin, Urine Random
CPT codes 82043-91 and 82570 for Microalbumin Creatinine Urine Ratio

 

[RaeToll]

I think I found my answer:

Modifier 91 is not to be used for procedures repeated to verify results or due to equipment failure or specimen inadequacy. While 59 is used for differentiating two procedures while cannot be billed together on same day.

Use of Modifier 91:​

• On a repeat lab test performed only to confirm initial results
• When a lab test was repeated due to a problem with the specimen or equipment
• When a series of lab tests would be better represented by another code; for example, glucose tolerance testing under code 82951 already includes 3 specimens under one code, so modifier 91 would not apply.

https://www.medisysdata.com/blog/appropriate-use-of-modifier-91/#:~:text=Use%20of%20Modifier%2091%3A%201%20On%20a%20repeat,one%20code%2C%20so%20modifier%2091%20would%20not%20apply.