Question LAB ORDERS: MODIFIERS

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Glendale, AZ
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I have a medical provider (NP) that is currently ordering labs when she sees the patients, but then follows up a few days later to review the results. Currently, she is coding 99358 (E/M non-face-to-face) for these reviews, which are not always paid depending on insurance. Labs are conducted offsite and she received the results for interpretation. Would it be more proper for her to code the panel/test that was ordered and use Modifier 26 (professional component) for these reviews?

**I am currently going through the AAPC CPB courses and the book does not provide answers on Modifiers TC and 26 under labs/pathology. Only under radiology.**
 

thomas7331

True Blue
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No, most clinical lab tests do not have a professional component, so it is not possible to bill a modifier 26. The only lab codes that allow for a modifier 26 are the pathology codes, which would would be billed for the interpretation and report performed by the pathologist reviewing the specimens, not by providers simply reviewing results.

99358 may be appropriate if the documentation shows that the NP spent more than 30 minutes reviewing these labs. That does seem like a lot of time to review a single patient's results, though. Normally, reviewing lab results is inclusive to the E&M service unless for some reason it requires an extensive amount of time.
 
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