Just an FYI, the approved modifier list for G0461 and G0462 are:
26, 52, 59, 90, 91, 99, AR, CR, ET, GA, GC, GR, GY, GZ, KX, Q5, Q6, QJ, QP & TC.
***76*** is not an approved modifier for these codes nor is it appropriate. Just because Medicare is allowing these codes to pass through their edit doesn't make it correct coding. More than likely, they will recoup on these charges once
more established guidelines are reviewed and charges start getting audited. Modifier 76 is intended for surgical and radiology usage only.
Modifier 91 Fact Sheet
Definition
? Repeat clinical diagnostic laboratory test
? In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results.
Appropriate Usage
? To identify a subsequent medically necessary laboratory test on the same day of the same previous laboratory test
Inappropriate Usage
? Used for a rerun of a laboratory test to confirm results
? Due to testing problems for the specimen
? Due to testing problems of the equipment
? When another procedure code describes a series test
? When the procedure code describes a series of test
? For any reason when a normal one time result is required
Modifier 76 Fact Sheet
Definition
? Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day.
Appropriate Usage
? On procedure codes that cannot be quantity billed
? Report each service on a separate line, using a quantity of one and append 76 to the subsequent procedures
? The same physician performs the services
Inappropriate Usage
? Appending to a surgical procedure code
? Appending to each line of service
? Repeat services due to equipment or other technical failure
? For services repeated for quality control purposes
Additional Information
? Medicare considers two physicians, in the same group with the same specialty performing services on the same day as the same physician
? For all procedure codes that cannot be quantity billed, always use a quantity of "1"
? To avoid denials, bill all services performed on one day on the same claim
? For repeat clinical diagnostic laboratory tests, use modifier 91 if the service cannot be quantity billed
? Indicate in the electronic narrative record or Box 19 of the CMS 1500 claim form, the total number of services performed that day
Correct Use Of Modifier 59 With Cytopathology Codes
Often it is not clear whether modifier 59 or modifier 76 should be used with repeat procedures. The Correct Coding Initiative (CCI) Manual provides guidance for the correct usage of modifier 59 with cytopathology CPT codes:
When cytopathology codes are reported, the appropriate CPT code to bill is that which describes, to the highest level of specificity, what services were rendered. Accordingly, for a given specimen, only one code from a group of related codes describing a group of services that could be performed on a specimen with the same end result (e.g., 88104-88112, 88142-88143, 88150-88154, 88164-88167, etc.) is to be reported. If multiple services (i.e., separate specimens from different anatomic sites) are reported, modifier -59 should be used to indicate that different levels of service were provided for different specimens from different anatomic sites. This should be reflected in the cytopathologic reports.
Also refer to Medicare's Processing Manual, Capter 16, Section 100.5.1- this is listed in your ICD-9 book in Appendix G-PUB 100 References as well under clinical laboratory services.
http://www.cms.gov/Regulations-and-...ternet-Only-Manuals-IOMs-Items/CMS018912.html
