Wiki Modifier 91

[lgb71862@gmail.com]

I am having issues for when it is appropriate to use Modifier 91. Especially when pertaining to pathology, hematolog and coagulation laboratory testing. Today it is 85245/85246. I have been taught that 91 is inappropriate to use with these types of codes. I was told that blood specimens get contaminated quickly so the testing is to be done 2x automatically. We are also receiving an edit that is denying the modifier 91 but the explanation is vague. Does anyone have something specific as to when Modifier 91 can be applied to path & lab testing? When it can or cannot be used? Thank you. I appreciate the help.

Modifier 91 is used to report repeat laboratory tests or studies performed on the same day on the same patient. This modifier is added only when additional test results are to be obtained subsequent to the initial administration or performance of the test (s) on the same day.

 

[lcolborn]

91 is to be used for a repeat test that is medically necessary, and it's not use to repeat test to rerun to confirm initial results, problem with the equipment, and cannot be used when other codes describe a series of test results. ( e.g., glucose tolerance tests). I'm not clear on the " blood getting contaminated and so another testing is automatically done" ......
With multiple or repeat codes on labs, I have been using a 59 modifier, not a 91 .

 

[lgb71862@gmail.com]

Thank you