Question Modifier 90

kjdallas

Networker
Messages
32
Best answers
0
HELP!
We are an independent lab, and we get samples from many offices in many different states. Should we be appending a modifier 90 to our labs that we bill for, but a different lab is actually doing the analyzing (and we pay them, until our equipment is ready)?
I hope this makes sense. NEED TO KNOW ASAP!
Thanks!
 

karamac

Networker
Messages
34
Location
Glendale, Arizona
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Yes, amend the 90 -- you also need to amend the CLIA and location of the lab on the claim form, as well as amend the result report to reflect by individual test the tests that were performed by the reference lab. Best practice is that you notify all of your clients that those tests are referenced.

Hope that this helps.
 

danachock

Guru
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214
Location
Brainerd, MN
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Hi, I have something to provide on this when billing Medicare.

Billing Provider: Independent lab, somewhere
Service Provider: Independent lab, somewhere
Dept: Independent lab, somewhere
POS: Independent lab, somewhere

If you are billing Medicare, do not bill with Modifier 90. Odds are your claim will be denied for inaccurate use of modifier.

Coding Specialist 3 - Pathology; Causual: Coding Analyst
Dana Chock RHIT, CPC, CANPC, CHONC, CPMA, CPB
 

karamac

Networker
Messages
34
Location
Glendale, Arizona
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Hi Dana,

I think I may be confused by your post. I have attached, from the Novitas website guidance specific to the use of the 90 modifier. I would be really interested in what your denial experience has been specific to the use of the 90. There has been quite a bit of legal activity specific to entities not appending the 90 in both the commercial and government space, and I have not come across a situation where the guidance was to not append it.


Modifier 90 - Referred Tests
What You Need To Know
A referring laboratory may bill for clinical laboratory tests on the clinical laboratory fee schedule performed by a reference laboratory only if the referring laboratory meets one of the following conditions:
Located in, or is part of, a rural hospital
Wholly owned by the entity performing such test. (referring laboratory wholly owns the entity performing such test, or both the referring laboratory and the entity performing such test are wholly-owned by a third entity)
Does not refer more than 30 percent of the clinical laboratory tests for which it receives requests for testing during the year (not counting referrals made under the wholly-owned condition described above)
Appropriate Uses
Only one laboratory may bill for a referred laboratory service
It is the responsibility of the referring laboratory to ensure that the reference laboratory does not bill Medicare for the referred service when the referring laboratory does
Referring laboratory may not bill in the event the reference laboratory bills or intends to bill Medicare
Claim Submission Instructions
Must include the referring and reference laboratory’s CLIA number.
Laboratory testing require the presence of the referring and reference laboratory’s name and address
The reference laboratory for a service with a 90 modifier requires the performing provider's information in the appropriate loop.
Loop 2310C must contain the NPI of the physician or supplier who actually performed the service and their complete address, even when the reference lab is located in another jurisdiction.
When the referring laboratory performs some laboratory testing, and some testing is referred to another laboratory:
The electronic claim will not be split
CLIA numbers from both the referring and reference laboratories must be submitted on the same claim
The referring laboratory submits, on the same claim, tests referred to another laboratory, with the 90 modifier reported on the line item and reports the reference laboratory’s CLIA number in the appropriate loop (line level)
Paper Claims

Block What is reported
32A Performing provider's NPI
32 Performing provider's name and complete address
23Reference lab CLIA number
24D (modifier) 90
For the electronic equivalent, please review Paper to Electronic Claim Crosswalk (5010).
Reference Lab Claim Processing
Message 302
NOC lab procedure code is reported and there is no additional terminology reported in block 19 or EDI equivalent or notes attached.
Message 653
The reference and referring lab both billed the procedure code for the same date of service.
 
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