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Modifier 59 vs 76

charles Aiesi Posted Tue 18th of March, 2014 15:37:21 PM

We sometimes will have 3 stomach biopsies, 2 esophagus, 6 colon, 1 duodenum. United health care allows 6 units of 88305 as their maximum. so do we bill the other six biopsies with a 59 modifier because they are different sites or do we bill a 76 modifier for repeat procedures.

SuperCoder Answered Wed 19th of March, 2014 15:38:59 PM

Some payers have directed coders to list each 88305 on a separate claim line with modifier 59 on the second and subsequent codes. Under the new policy stated by Cahaba, Noridian, and other Medicare payers, using modifier 59 in this way for multiple units is a problem.

Solution: Choose the proper modifier such as 76 or 91, as Noridian recommends. In a case like the preceding example involving multiple units of a pathology exam on distinct specimens, modifier 76 is more appropriate.

Best way is to contact payor about the proper usage accordingly.

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