Wiki 80048 and 84132

[woodsusa]

If a physician orders 80048 and subsequently orders 84132 on the same date of service, which modifier is appropriate, -59 or -91 ?
Per the FAQ on the CMS web on "How should modifier -91 be reported under CCI?"
"...the physician had to perform a repeat clinical diagnostic laboratory test that was distinct or separate from a lab panel or other lab servcies performed on the same day..."
Thank you for your help.

 

[ajs]

If a physician orders 80048 and subsequently orders 84132 on the same date of service, which modifier is appropriate, -59 or -91 ?
Per the FAQ on the CMS web on "How should modifier -91 be reported under CCI?"
"...the physician had to perform a repeat clinical diagnostic laboratory test that was distinct or separate from a lab panel or other lab servcies performed on the same day..."
Thank you for your help.

First question, does the physician have a lab in office that is actually running this test? If so, then the 91 modifier would be correct.

If the physician bills the lab tests to insurance for the outside lab, then it would also be correct.

 

[woodsusa]

Thanks Arlene, I should have stated that this is an outpt hospital claim for the facility (ED visit)

 

[ajs]

Thanks Arlene, I should have stated that this is an outpt hospital claim for the facility (ED visit)

ahhh yes that does change the perception...