Wiki Modifier 91 or 59

[IABrat]

We are having a debate we had a patient come in and have a urine culture done which grew two different pathogens. They charged for a UA, Urine Culture, Urine ID x2, and Sensitivities x2. Should a modifier 91 or 59 be appended to the Urine ID and Sensitivities?

Any help would be appreciated.

 

[ajs]

We are having a debate we had a patient come in and have a urine culture done which grew two different pathogens. They charged for a UA, Urine Culture, Urine ID x2, and Sensitivities x2. Should a modifier 91 or 59 be appended to the Urine ID and Sensitivities?

Any help would be appreciated.

The definition of modifier 91 is:
"In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. "

 

[btadlock1]

We are having a debate we had a patient come in and have a urine culture done which grew two different pathogens. They charged for a UA, Urine Culture, Urine ID x2, and Sensitivities x2. Should a modifier 91 or 59 be appended to the Urine ID and Sensitivities?

Any help would be appreciated.

Technically, since it's 2 different pathogens, the correct modifier is 59; but, depending on the payer, you may have to use 91, anyways. I know that TX Medicaid requires a 91 modifier when multiple labs are billed, regardless of whether or not it was truly a 'repeat lab', so it's worth checking the payer's policies, particularly for Medicaid.

From a CPT standpoint, though:
59 = Looking for/at 2+ different species, sites, or specimens (eg, Testing for both influeza types A & B)
91 = Running the same test, looking for the same thing, at 2 different points in time, during the same date of service (usually after some kind of variable has been added)