Wiki modifier 59 vs 91 on multiple 87040 tests

ens555

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Regarding blood cultures CPT 87040 I read that typically 2 or more samples are drawn from separate venipuncture sites typically different veins in the arms. My question is whether this is understood in considering modifier 59 or must we have documentation that say, right & left arm sites were used? I am uncertain whether to apply modifier 91 or modifier 59 when I do not have the site documentation for 2 units 87040.
 
87040, Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates

First, if it wasn't documented, then it wasn't done.

Second, here are Quest Lab's instructions for the draw on this test (just as an example):

Strict aseptic technique is essential. If more than one culture is ordered, the specimens should be drawn separately at no less than 30 minutes apart to rule out the possibility of transient bacteremia due to self-manipulation by the patient of mucous membranes in the mouth caused by brushing teeth, etc, or by local irritations caused by scratching of the skin.

• Suspected sepsis, meningitis, osteomyelitis, arthritis, listeriosis, or acute untreated bacterial pneumonia: Obtain two blood cultures from two different sites, such as the left and right arms.

• Fever of unknown origin such as that caused by an occult abscess: Obtain two blood cultures initially. If those are negative, obtain two more 24 to 36 hours later. The yield beyond three or four cultures is virtually nil in this condition.

• Suspected early typhoid fever and brucellosis: Obtain four blood cultures during 24 to 36 hours due to low-grade bacteremia involved in these rarely seen diseases.

• Endocarditis (acute infective endocarditis): Obtain three blood cultures from three separate venipuncture sites during the first one to two hours and begin therapy.

• Subacute infective endocarditis: Obtain three blood cultures within the first 24 hours, ideally within no less than hourly intervals. If all are negative at 24 hours, obtain two more. The yield beyond five blood cultures in subacute and endocarditis is virtually nil.
 
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