Jamie Posted Mon 17th of October, 2016 14:25:04 PM
We have a test done for Ova & Parasites (CPT 87177 & 87209) we usually test 3 samples. We use to code both CPT 87177 & 87209 x3(units) and insurance was paying it up until May of this year. They are denying it now for maximum number of times allowed. So I corrected and billed to 87177, 87177-59,87177-59 & 87209,87209-59,87209-59. They are still denying for max number of units. How are we suppose to bill this test correctly when 3 samples are run and the max units are 1. Is there another way to bill or somewhere where we can check the max units for a particular code??
SuperCoder Answered Tue 18th of October, 2016 03:18:25 AM
CPT has provided coding guidance for this within the Microbiology subsection notes, which state "For multiple specimens/sites use modifier 59." Please provide with some more laboratory details to give the appropriate units.
Jamie Posted Wed 19th of October, 2016 18:21:58 PM
I have submitted with mod 59 & notes and they say that the CPT code has an edit that the max can be billed is once per day. What are my options?
SuperCoder Answered Sun 23rd of October, 2016 13:50:41 PM
It is more appropriate to submit you documentation with modifier 91. This modifier is used for laboratory test(s) performed more than once on the same day on the same patient.
For further clarity please see the below mentioned examples:
- For multiple specimens/sites/patient/day use modifier ‘-91’
Example: blood for malaria (receipt of more than one specimen/patient/day). This is a repeat of the same test to increase analytical sensitivity
- For repeat laboratory tests performed on the same day/patient, use modifier ‘-91’.
Example: multiple wet preparation exams for duodenal aspirate (examination of more than one wet preparation from a single specimen/patient/day).
- For multiple stool specimens collected on different days, but submitted to the laboratory on one day: code for separate dates (no modifier required).