Wiki Modifier 59 Vs. 91

[cfeilner]

Hi All.
I am trying to determine when the facility charges more than 1 urine test CPT 80307 (MUE only allows 1 with mod), Should I be adding the modifier 59 or 91 to the second 80307 line charge? TIA

 

[NiteshlalKoyalkar]

Hi,
i think adding an 59 mod in this case will do your work.
code as follows:
80307
80307-59(second line item)

 

[thomas7331]

MUE edits cannot be overridden with a modifier. The MUE edit for this code is 1 per date of service and it is a policy edit based on the CPT descriptor, so it is a 'hard' edit that you cannot bypass. The CPT descriptor for 80307 is "any number of drug classes, any number of devices or procedures...per date of service" so it would not be correct coding to submit multiple units for this code on the same date. In my experience, even with an appeal these denials are not paid.

 

[cfeilner]

Thank-you both for your response