tci Outpatient Facility Coding Alert - 2015 Issue 2

You Be the Coder: Know When to Use Modifier 59 and Modifier 91

Question: According to our billing department, Coventry Insurance requested modifier 59 on the second flu screening test. Usually we code it by appending modifier 91 on the second screening line, and we have been getting paid. We believe modifier 59 is for a distinct procedural service not a repeat clinical diagnostic laboratory test like modifier 91. Could you please clarify? New Jersey Subscriber Answer: You are correct in your understanding of the modifiers. You would use modifier 59 (Distinct procedural service) when separate results are reported for different species or strains that are described by the same code. Payer...

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