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Modifier-59 help!

  1. #1
    Default Modifier-59 help!
    Medical Coding Books
    Does anyone know if you can use modifier 59 on 82962 (finger stick glocuse)?

    I have a scenario where labs are being done and they are appending a 59 modifier to the second lab. The labs being performed are 83036 (A1C) and 82962 (Glucose finger stick)-59. I have never seen this modifier appended to this lab before.

    Thanks in Advance,
    Dawn
    Dawn Smith, CPC
    [email]dsmith28@iuhealth.org

  2. #2
    Default 59 modifier
    Quote Originally Posted by dawn1170 View Post
    Does anyone know if you can use modifier 59 on 82962 (finger stick glocuse)?

    I have a scenario where labs are being done and they are appending a 59 modifier to the second lab. The labs being performed are 83036 (A1C) and 82962 (Glucose finger stick)-59. I have never seen this modifier appended to this lab before.

    Thanks in Advance,
    Dawn

    I would think it would be a 91 instead of a 59. In my modifier book "Coding with Modifiers" edition 3 page 245 Modifier 91 it says:

    "Modifier 91 may be appended to a laboroatory code to indicate that a laboratory test was performed multiple times on the same day for the same patient and that it was necessary to obtain multiple results in the course of treatment. The note included in the test of the modifier indicates that modifier 91 is not intended to be used when laboratory tests are rerun."

    Page 246:
    Modifier 59 is used to identify procedures or services not usually reported together but are appropriate under the circumstances, including a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury( or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. Modifier 59 is used only if no more descriptive modifier is available and using modifier 59 best explains the circumstances.

    I use the 59 for different methodologies as in cultures. You might have the same CPT code, but different method of testing when they set up the cultures. That would require a 59 modifier.
    In the case of glucose testing, I think a modifier 91 would best fit as sometimes they need several tests done during the day and it's the same test method, done on the same type specimen and the same CPT code.

    Sorry, didn't mean to go on and on.

  3. #3
    Default
    These are two different labs and no bundling issues so you wouldn't need a modifier. If you did report the same lab CPT code more than once on a claim you'd probably need the 91 modifier on the second one but some payers do want the 59 modifier instead of the 91.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. Default
    What if the physician orders a test of the same specimen on a different day from the initial test, and collection of the specimen. Would you code the lab test for the DOS it was actually performed?

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