Results 1 to 3 of 3

Modifier 91 or 59

  1. #1
    Default Modifier 91 or 59
    Exam Training Packages
    We are having a debate we had a patient come in and have a urine culture done which grew two different pathogens. They charged for a UA, Urine Culture, Urine ID x2, and Sensitivities x2. Should a modifier 91 or 59 be appended to the Urine ID and Sensitivities?

    Any help would be appreciated.

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by IABrat View Post
    We are having a debate we had a patient come in and have a urine culture done which grew two different pathogens. They charged for a UA, Urine Culture, Urine ID x2, and Sensitivities x2. Should a modifier 91 or 59 be appended to the Urine ID and Sensitivities?

    Any help would be appreciated.
    The definition of modifier 91 is:
    "In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. "
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    Quote Originally Posted by IABrat View Post
    We are having a debate we had a patient come in and have a urine culture done which grew two different pathogens. They charged for a UA, Urine Culture, Urine ID x2, and Sensitivities x2. Should a modifier 91 or 59 be appended to the Urine ID and Sensitivities?

    Any help would be appreciated.
    Technically, since it's 2 different pathogens, the correct modifier is 59; but, depending on the payer, you may have to use 91, anyways. I know that TX Medicaid requires a 91 modifier when multiple labs are billed, regardless of whether or not it was truly a 'repeat lab', so it's worth checking the payer's policies, particularly for Medicaid.

    From a CPT standpoint, though:
    59 = Looking for/at 2+ different species, sites, or specimens (eg, Testing for both influeza types A & B)
    91 = Running the same test, looking for the same thing, at 2 different points in time, during the same date of service (usually after some kind of variable has been added)
    Last edited by btadlock1; 01-17-2012 at 09:31 AM.

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.