Wiki 91 vs 59

[YamiliaNelson]

I code pathology, I have mutilple biopsy of a prostate...up to 18 specimens at one time. I found out thru Medicare trial and error that 12 units are accepted on one line. If I have 18 specimens, I split the line and add the 59 modifier to any additional to the 12 that I know will be paid. Question is 59 modifier good to use or should i be using the 91 modifier? Currently the service are paid when using the 59, but in a class review I learned about 91 and now I am second guessing the 59.

 

[niecey50]

I work with a lab company. We bill G0431 and 1 unit @ $250.00. Medicare has denied the 80101 code. But when using the 84311, or the 82542 we use the 91 modifer and our payments have been fine. Have you used the 59 mod with any other company that allows the 80101 and 15 units?