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Thread: Clarification for coding lab procedures

  1. #1
    Join Date
    Apr 2007
    Capital Coders in Columbia, SC

    Question Clarification for coding lab procedures

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    I am trying to provide uniformity for all of our labs in the area of coding. My understanding is that for codes with the word "each" as in each specimen, each antibody or just the word each, we should code the procedure as one line item with the number of units listed and no modifier. The same thing would go for add-on codes including the phrase "each additional" in the descriptor. However, when coding a procedure for which the descriptor does not include the word "each", we should code each occurrence as a separate line item with either modifier 91 (for repeat of the same procedure) or modifier 59 (when the CCI or MUE restricts the number billed in one day or when it is a different CPT code). Although there are articles instructing on the difference between modifiers 91 and 59, I have not been able to find anything about the issue of "each" that would pertain particularly to lab testing. I would assume that we should apply the same theory as we would to other areas of CPT. I would appreciate your comments on this.

  2. #2
    Join Date
    Apr 2007
    Scranton, PA


    You are correct. That is how we do it at our facility. However, we have had some issues with our Medicare FI with MUE edits on these services. Even though the CPT description reads "each" or "each additional" Medicare still has some MUE edits on these services limiting the number of units that can be charged. I have never seen anything in writing defining "each" either by any payer. For the most part these process fine with the payers using the multiple units. I will caution you however on using the modifier 59 on lab services. I realize there are times it is appropriate but we found that our billing office was just using that modifier to push claims through when it really was not appropriate. We found this in a routine internal audit.

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