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88104 with 88112 / -59 modifier

Christine Posted Wed 11th of February, 2015 16:10:34 PM

When is it alright to use this below?

88104 with 88112 / -59 modifier

SuperCoder Answered Fri 13th of February, 2015 07:15:26 AM

As per CCI Edit Checker, CPT Code 88104 is a column 2 code for 88112 but modifier like -59 is allowed in order to differentiate between the services provided.

As per NCCI Edits, CPT code 88104 can be billed with 88112 with 59 modifier, if:

If multiple services (i.e., separate specimens from different anatomic sites) are reported, modifier 59 should be utilized to indicate that different levels of service were provided for different specimens from different anatomic sites. This information should be documented in the cytopathology reports.

Example: A Lab receives a bronchial washing and a bronchial brushing. It uses a thin-layer preparation technique to perform the bronchial washing and make a direct smear of the brushing. Because the preparations being evaluated are from two distinct specimens, the lab would report both the directly prepared smear and the cellular enhancement preparation as separate services using codes 88112, Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid based slide preparation method), except cervical or vaginal and 88104, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation. In such a situation, modifier -59 should be appended to CPT code 88104 to inform the payer that the services are separate, not unbundled.

Christine Posted Fri 13th of February, 2015 09:58:33 AM

we have a specific scenario to check
1. WE receive a peritoneal fluid:
- we prepare 1 thinprep slide (88112)
- 2 smears are made from the fluid (88104-59)

Is this correct?

SuperCoder Answered Mon 16th of February, 2015 03:28:30 AM

In the mentioned scenario, CPT code 88104 cannot be billed with 88112 with 59 modifier, because the sample is still same, i.e., peritoneal fluid. And to support 59 modifier, there should be different specimens from different anatomic sites.

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