Wiki Can I put modifier 59 on a lab charge?

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KaitlynEFitch

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I am billing to Medicare, doing one unit per line as I was told to do.. but they are denying the second lab, probably because they don't see that it is a separate procedure.

Should I do
88305 X2
or
88305
88305 (59) ?
 
what I mean is that it's not a repeat test.. it's just that he did that same test on 2 different samples.
 
You want to use a 91 when you want to obtain reportable test values for multiple results for procedures done by the same physician on the same day. Normally if a test is rerun to confirm results or because of an error, you wouldn't use a 91.

Hope this helps!
Holly
 
88305 Pathology

Hi,
88305 is a Level IV Gross & Microscopic for pathology. If you are going to bill more than one unit you will need to use the modifier 59 on the second charge. The only payer that I know that likes things billed differently is the VA - if your payer is the VA - please let me know for further guidance.

Professional Fees
1st specimen 88305 modifier 26
2nd specimen 88305 modifier 26,59

Technical Fees
1st specimen 88305 modifier TC
2nd specimen 88305 modifier TC,59

Thanks,
Dana Chock, CPC-A, CCA, CANPC, CHONC
 
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