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Wiki Use of Modifier 59 and Lab CPT's

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khrigsby

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Hi,

Recently we have been working with our business office on finding a new work flow that works better for coders and billers alike. One thing the billing office is asking us to do is add Modifier 59 to certain labs. For example CPT 81001, 81003, and 81015. We have also received similar requests for CBC's ran with hemoglobin. I would love to be able to research the use of modifier 59 with lab CPT's but I am coming up empty handed. Any help would be greatly appreciated. Thank you!
 
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khrigsby said:
Hi,

Recently we have been working with our business office on finding a new work flow that works better for coders and billers alike. One thing the billing office is asking us to do is add Modifier 59 to certain labs. For example CPT 81001, 81003, and 81015. We have also received similar requests for CBC's ran with hemoglobin. I would love to be able to research the use of modifier 59 with lab CPT's but I am coming up empty handed. Any help would be greatly appreciated. Thank you!
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You should start with NCCI. This main page for NCCI is a great starting off point to navigate around all the NCCI info: https://www.cms.gov/medicare-medica...-correct-coding-initiative-ncci/ncci-medicare

The links below can also be reached by navigating around the site I linked above:

NCCI Coding Policy Manual. Chapter 10 Pathology/Laboratory: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-10.pdf

The PTP edits are here: https://www.cms.gov/medicare-medica...e/medicare-ncci-procedure-procedure-ptp-edits
 
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sls314 said:
You should start with NCCI. This main page for NCCI is a great starting off point to navigate around all the NCCI info: https://www.cms.gov/medicare-medica...-correct-coding-initiative-ncci/ncci-medicare

The links below can also be reached by navigating around the site I linked above:

NCCI Coding Policy Manual. Chapter 10 Pathology/Laboratory: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-10.pdf

The PTP edits are here: https://www.cms.gov/medicare-medica...e/medicare-ncci-procedure-procedure-ptp-edits
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Thank you so much!
 
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