Modifier 91

Quest ion:

Can you provide us with examples of how to properly use the 91 modifier with surgical pathology?We received some articles about the 91 modifier and it states it can be used with repeat tests. Does this count if say, a pathology report has two polyps and were charged 8835 x 2?Would we use the 91 modifier then?

Answ er:

Because multiple surgical specimens may be collected for examination during the same procedure, Medicare assigned a Medically Unlikely Unit (MUE) of16to 88305

Modifier 91 may be reported, when appropriate,to bypass an NCCI edit that prevents some procedures from being reported on the same claim as others Modifier 91 indicates repeat testing is medically necessary and reasonable. It may not be added to confirm the initial results Given the high number of MUEs and the requirements for reporting, it?s unlikely modifier 91 would need to be appended to pathology code 88305.

Medicare Claims Processing Manual, Chapter 16, Laboratory Services, Section 100 5 1

CPT® Appendix ? A provides the following description: ?91. Repeat Clinical Diagnosis Laboratory Test: (OPPSAND ASCAPPROVED) 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.?

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