Forum - Questions & Answers

Jun 10th, 2011 - pvang 4 

Lab question

Hi-

Anyone know laboratory billing well? Provider is billing CPT® 86022 with 7 units and 86023 with 3 units. Our system is denying these two claim lines as the service units have been maxed. I checked the CMS website and the MUE for 86022 is 1 and 86023 is 3. The itemized bill for this DOS indicated that there were multiple antibodies screening done.
Would it be appropriate to append a modifier (59) onto these two codes if the testing was to identify a certain antibody?

Thanks in advance!!

Jun 10th, 2011 -

re: Lab question

Since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable providers/suppliers to report medically reasonable and necessary units of service in excess of an MUE value. CPT® modifiers such as -76 (repeat procedure by same physician, -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test) and -59 (distinct procedural service) will accomplish this purpose. Modifier -59 should be utilized only if no other modifier describes the service



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