Modifier 91 used for same dx?

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I received a denial from BlueAdvantage (Medicare) and they are saying that they do not like the modifier 91 appended to this scenio...

88304- dx code...L72.3
88304-91-dx code...L72.3, same as the previous code.

Two bx performed this day, so 2 path charges.

Does anyone have any input on this? This practice has always used the 91 modifier to show the same diagnosis code from what I was told. I read that the modifier 91 is used for the "Repeat Clinical Diagnostic Laboratory Test." It does not say anything same dx for same cpt code.

I am thinking that modifier 59 would be more appropriate????

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I checked the guidelines for 88304 and it doesn't show either a 91 or a 59 as an acceptable modifier. However, I did find this:

"The unit of service for codes 88300 through 88309 is the specimen.

A specimen is defined as tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis. Two or more such specimens from the same patient (eg, separately identified endoscopic biopsies, skin lesions) are each appropriately assigned an individual code reflective of its proper level of service."

88304 has an MUE of 5. So considering that one unit is one specimen, you have two "specimens" (= 2 units), and both met a level III, I'm wondering if 88304 with 2 units would work. :confused: You'd probably have to provide documentation to support it, and there would have to be two clearly distinct reports (one for each "specimen"), but it's worth a shot if no one else has any other ideas.


True Blue
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1 line with 2 units is what you want to bill if there are 2 specimens. Modifier 91 is not meant for this type of situation. 91 is the same CPT code during separate patient encounters for instance bloodwoork in the morning and then a repeat later in the day.