Wiki Modifier 90-We're having

[OneStepAtATime]

Hi folks!

We're having a hard time getting strep test kit 99070, and 87880 strep test, and 99000 spec. handeling paid for....

Can I put a Mod-90 on any of these to help them get paid?
I was thinking putting Mod-25 on the office visit charge, and then Mod-90 on 87880 & 99000.... can I do that??

Can anything bad happen if I put a modifier, and it doesn't need one???

***LOST***

 

[mjb5019]

mod 90

Why do you feel you are eligible to use mod 90? Are you a lab? What will happen if you use a modifier that isn't needed? In the bes scenario- the insurance may pay it anyway, or they may deny the claim based on incorrect coding, or they may deny the claim because the POS doesn't match the modifier. Do you know what a reference lab is and what it does?

 

[OneStepAtATime]

Guru--

My boss and I were under the impression that MOD-90 could be used if there were, lets say; cultures done in the office that had to be sent out, to an outside lab.... therefore the MOD-90 on CPT code 99000????

Is MOD-90 only to be used if *I* were the lab??

How can I get insurance to pay for 87880? Is this bundeled with the office visit?
Also, can I get 99070= strep test kit, paid? If so, how?

Thank you for your help.
~Elle

 

[OCD_coder]

If you send the strep test to the lab to process and you pay the lab directly, in other words they are not billing for insurance payment; this would be the correct way to bill for your strep test 87880-90.

If you are collecting the specimen in your office and processing the test and no outside lab is involved you can bill for the lab test 87880 with no modifier appended. The cost of the kit is included in the 87880 and not billable separately.

If your office is collecting the specimin for the strep test only, you would just be able to capture the work in the E/M only.

Most insurances/Medicare do not cover for the actual test kit or handling/obtaining specimen's (99000), insurance and medicare consider that part of doing business. You would have to be really careful about using the 99070 for a strep kit when you have to have a kit to run the test. What is over and above what would be usually needed to do the strep test?
CPT description:
99070 = Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided). For the most part this would be a tracking code for the office only.