Wiki Surgical Patholgy question

[amys911]

A coworker of mine has run into a problem with United Heathcare. THey are telling her to use modifier 76 or 77 on her pathology codes 88300 - 88309 instead of modifier 59 if there is more than one done on a day - which happens frequently. I wasnt sure if this was correct as its not 2 doctors looking at the same specimen, it is the same procedure done on different specimens. Does anyone know that could give us some advice??

 

[FTessaBartels]

Mod 76

Mod 76 is for a "repeat procedure" done on the same day or within the global period. So I think it would apply if you have the "same procedure on a different specimen."

F Tessa Bartels, CPC, CEMC

 

[mannlx]

i don't agree, I do lots of path coding and never see repeat service, yes we use the same codes over and over, but it is not a repeat service, it is a different specimen, so 59 is the correct modifier, in fact a few insurance will deny pathology coding outright if you use a 76 or77 modifier because they state this is an invalid modifier for these cpt codes (88300-88309)

 

[whaleheadking]

59 is the correct modifier if one is needed. You would never repeat an 88307 on the same specimen. Nor would you bill more than one of these codes on the same specimen (ignoring unbundling rules of course). United Healthcare may have thier own ideas, but I've never heard of this one.

 

[JEYCPC]

We add the 76 or 77 when the specimen (accession#) is different but the procedure is the same for 88300-88309.

If it's different specimens on the same accession we use the 59 modifier. Hope this helps.