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Modifier 59 VS 91

  1. Default Modifier 59 VS 91
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    When billing CPT 83516 X 3 units, do you use modifier 59 or 91 to indicate testing for 3 separate antibodies? Thanks.

  2. Default
    I would use 59. Modifier 91 is a repeat of the same test at different times. In this case you're doing 3 different antibodies, not the same one. Thanks!

  3. Default
    If the tests are rerun to confirm results you wouldn't use 91 but if the results are for different antibodies I would use 91 not 59. 59 is a Distinct Procedural Service code for different session, different procedure or surgery. Since you are using the same procedural code it wouldn't be different. Always reading guidlines for modifiers is important. Make sure you submit documentation for the code showing that they are for different antibodies when using modifier 91 and not that the labs are just being rerun.
    Brian Hazel
    Last edited by; 04-04-2011 at 10:55 AM. Reason: typing error

  4. #4
    Modifier -91 is appended to repeat clinical diagnostic laboratory tests performed on the same date. If the same test was performed on different sites, use modifier -59 instead. For example, if two wound cultures were taken from two different wound sites, modifier -59 would be appended to the second wound culture code. However, if a second culture was taken of the same wound site, then it would be appropriate to append modifier -91 to the second wound culture code. If a lab panel is performed and one of the tests within the panel is repeated, modifier -91 is appended to the repeat lab test.

    I would use modifier 59 to indicate different antibody testing and also use the corresponding dx code for each separate 83516.

    I would not use modifier 91 since you are not technically repeating a test that was taken earlier.

    Hope that helps.
    Errika Jenkins, CPC
    [Medicare Risk Adjustment Learning Facilitator
    Humana Insurance Co

  5. Default Modifier 59
    If I use modifier 59 would there be reduced payment on the second procedure? For example:
    10022 billed at $100
    10022-59 billed at $100

    would I have $50 payment for 10022-59?

  6. Default
    You are thinking of modifier 51, Multiple Procedures, where there is one preparation-same session, same peformer, same overhead- for several procedures. The first procedure is paid at 100%, the second at 50% and the third at 20%(?). 51 is not the correct modifier for 3 analytes. The same CPT is used for each, however, each is a completely separate test (no repeat.) Therefore, I believe you should use modifier 59 on all but the first CPT.

  7. Default
    You are thinking of modifier 51, where, because the same provider in the same session, does more than one procedure, and overhead can already be attributed to the first procedure, payers feel justified in paying 100% for the first procedure, 50% for the second, and 20% (?) for the third, etc . In the case of the 3 analytes, you are performing three tests represented by the same CPT code, however, each test is distinct. Therefore, I would code the first with no modifier and the next 2 with modifier 59. [Modifier 91 is used for repeat tests on the same day to, for example, obtain subsequent readings for comparison.]

  8. Default 83516
    For the inflammation, if we are using 2 kits one for the right another for the left eye we should use modifier 59? Is this correct? Mary Lou

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