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Thread: Modifier 59 or 91 for Pathology

  1. #1
    Join Date
    Apr 2007

    Default Modifier 59 or 91 for Pathology

    AAPC: Back to School
    Which modifier is more appropriate for use in billing for 88305, surgical path exam of two colon polyps from different sites, modifier 59 or modifier 91? Can you provide rationale and/or a source please.
    Jenny Berkshire, CPC, CEMC, CGIC

  2. #2
    Join Date
    Apr 2007
    Albany, New York


    Per the information in the CPT Assistant below, a modifier would not be used.
    Instead, your multiple specimens would be identified with units.

    CPT Assistant, September 2000 Pages: 10,11
    Category: Coding Consultation

    If two skin lesions are submitted together and are not separately identified, would this be reported as one or two specimens?

    AMA Comment

    The unit of service for the surgical pathology codes 88300-88309 is the specimen. A specimen is defined as tissue(s) that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.

    Therefore, when material received for pathologic examination comprises multiple specimens, each specimen is considered a single unit of service and should be reported using a single code. For example, if two separate skin lesions are separately identified and submitted in a single container, the physician work related to each of these separately identified specimens would be reported as two units of service with code 88305. If, however, two separate skin lesions are submitted together and are not separately identified, then this would be reported as a single specimen as one unit of service with code 88305.
    Last edited by magnolia1; 09-27-2009 at 06:46 AM. Reason: spelling
    Karen Maloney, CPC
    Data Quality Specialist

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