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Modifier 59 with Hematocrit and Urinalysis procedure during Well Care Visit

Sandra Posted Tue 26th of March, 2013 15:14:55 PM

When we do a well care check, we perform a hematocrit and urinalysis. We have been denied payment for the urinalysis, the insurance company states it is incidental to the hematocrit.

We have been told that we should use modifier 59 on the urinalysis to get around this denial.

Can someone provide documentation for this way of billing the insurance.

Thank you.

SuperCoder Answered Mon 01st of April, 2013 20:10:15 PM

This rule of urinalysis being incidental to hematocrit appears to be payer-specific. If the company/plan’s written policy is that urinalysis will not be paid in addition to hematocrit, then you’ll need to work directly with the company to explain why the urinalysis is not incidental clinically or in the resources used in hopes of getting the policy changed. If this is the stated policy, then the payer could consider using mod 59 in this situation to be a compliance issue.

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