tci Medicare Compliance & Reimbursement - 2014 Issue 24

Reader Question: Ask Payer Preference for Modifier 91 vs. 59

Question: Our lab performed a basic metabolic panel with total calcium, and the physician ordered a repeat total calcium test later the same day based on an abnormal finding. How should we code the repeat test? Answer: Because total calcium is part of the initial basic metabolic panel that your lab performed (80048, Basic metabolic panel [Calcium, total]), billing the stand-alone test may look to the payer like you’re unbundling. That’s why you should append a modifier to the calcium test, 82310 (Calcium; total) when you bill for the test performed the same day as 80048. Payer...

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