Susan Posted Fri 03rd of June, 2016 13:37:04 PM
When should modifier 91 be used on pathology? We recently were told by BCBS in order for us to get paid the full amount for our pathology we need to use modifier 59 or 91. What are the rules?
SuperCoder Answered Mon 06th of June, 2016 08:22:12 AM
we will use modifier 91 when the lab provider needs to obtain subsequent, or multiple, lab test results to better monitor the patient’s condition.
For example, a lab provider performs a glucose test for a patient, and the test shows that the patient has hypoglycemia. The patient takes glucose supplements, and the lab provider performs the test again 30 minutes later. The second test reveals that the patient’s glucose levels are normal. The lab provider should report the first glucose test with the appropriate CPT code and then report the second glucose test with the same CPT code, appending modifier 91. Modifier 91 tells the payer that the second test was not a duplicate but was medically necessary. However, Do not use modifier 91 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.
Modifier 59 (Distinct procedural service) is used, when separate results are reported for different species or strains that are described by the same code.