Pathology/Lab Coding Alert

Question: Which modifiers should be used for multiple pathology specimens? For example, we received a skin biopsy revealing a nevus of the leg and arm on the same day. We assumed we should use modifier -59 to explain different sites but have now been advised by two sources to use modifier -76 and modifier -91.

Nebraska Subscriber

Answer: No modifier is required to report multiple pathology specimens for the same patient on the same day, such as the example given of multiple skin biopsies. If the specimens are individually marked and identified as coming from separate sites, each represents a distinct specimen. The appropriate coding for the example would be 88305 x 2 (Level IV Surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair). The pathology report should include a separate entry and diagnosis for each skin specimen.

Use modifier -59 (Distinct procedural service) to report procedures that are usually considered bundled but that in these particular circumstances represent "a different site or organ system, separate incision/excision, separate lesion or separate injury," according to CPT direction. The surgical pathology codes are not bundled, according to the Correct Coding Initiative (CCI) edits.

Modifier -91 (Repeat clinical diagnostic laboratory test) indicates that a clinical diagnostic laboratory test was repeated for the same patient on the same day to obtain subsequent reportable results used for diagnosis and treatment of the patient. This would mean a repetition of the same clinical lab test, such as a glucose determination (e.g., 82947) in the morning, and a second glucose (82947) in the afternoon. Modifier -91 might also be used if a lab panel such as the renal function panel (80069) is carried out, and one of the panel tests, such as carbon dioxide (82374), is subsequently repeated for a second reportable value.

Modifier -76 (Repeat procedure by same physician) is used for repeat surgical procedures, as CMS direction describes the use of modifier -76, "to indicate that a procedure or service was repeated in a separate operative session on the same day." Some local Medicare carriers require that pathologists report multiple units of surgical pathology service with modifier -76. Consult your local carriers.