Pathology/Lab Coding Alert
Understand Modifier 59 Column Distinction
Question: When we need to override an edit pair that CCI lists in the "mutually exclusive" table, which code takes modifier 59 -- the column 1 or column 2 code? Iowa Subscriber Answer: According to CMS instruction, you should append modifier 59 (Distinct procedural service) to "the secondary, additional, or lesser procedure(s) or service(s)." See Chapter 23 of the Claims Processing Manual (Internet Only Manual 100-04), Section 20.9.1.1.B. The Correct Coding Initiative (CCI) places edit pairs in two different tables -- "column 1/column 2" and "mutually exclusive." CCI used to call the former "comprehensive/component" edits, and that name still describes the relationship of most edit pairs in the column 1/column 2 table. In other words, the column 2 code is usually the "lesser" procedure that CCI considers a component of the more "comprehensive" column 1 service. For the mutually exclusive table, however, the "lesser" service (in terms of RVUs) may be in column 1. For instance, CCI lists 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) in column 1 of the mutually exclusive edit table paired with 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report) in column 2. Note: Some coding experts advise that you always append modifier 59 to the column 2 code. You should check with your payers to ensure that you-re using the modifier according to their instruction.
Pathology/Lab Coding Alert
- ICD-9 Update:
Brace Yourself for a Plethora of New Pap Test Codes
Discover a new way to report vaginal findings. You already know to look to ICD-9 [...] - ICD-9 Update:
Take on 796.7 for Accurate Anal Pap Smear Coding
Stop using -other site- for anal smears. Starting Oct. 1, you won't have catch-all code [...] - CMS Regulatory Update:
Zero In On Correct 'Date of Service'
Treat pathology technical component like lab specimen. Don't get caught unawares when CMS implements the [...] - Make Sure You Get Travel Allowance for Specimen Collection
Medicare will pay for trips to nursing homes or homebound patients. If the cost of [...] - You Be the Coder:
Distinguish Specimens and Antibodies for Breast Case
Question: For a breast case, we used an AE1/AE3 immunostain on serial sections from multiple [...] - Reader Questions:
Beware Coverage Limits for Fecal DNA Test
Question: Our lab wants to start using PreGen-Plus, a commercially-available DNA stool test for colorectal [...] - Reader Questions:
Understand Modifier 59 Column Distinction
Question: When we need to override an edit pair that CCI lists in the "mutually [...] - Reader Questions:
Use Screening Pap Code Regardless of Findings
Question: If our lab runs a screening Pap smear but the findings are abnormal, should [...] - Reader Questions:
Identify GTT by 'Glucose Challenge'
Question: A physician ordered seven glucose blood tests over a three hour time period, including [...]
