decisionhealth Newsletters, Part B News - 2014 Issue 11 (November)
Modifier 91: Find solution to denials triggered by lab service modifier
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Article Overview
This article explains payer and Medicare guidance related to repeated laboratory testing claims, with attention to denial trends, audit exposure, and confusion between common modifiers used in coding workflows. It is aimed at coders, billing staff, and specialty practices that submit lab-related claims and want to understand the general compliance issues discussed in the article.
Why This Topic Matters
The topic is important because repeated lab-test reporting can affect claim acceptance, denial rates, and audit risk for practices that bill laboratory services. Understanding the article helps readers assess whether their billing patterns align with broader payer guidance and coding compliance concerns.
Article Sections
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Coding
Overview of the billing and compliance concerns associated with repeat laboratory testing claims, including denial trends and audit scrutiny.
What You Will Learn
- How the article frames payer concerns around repeat laboratory test claims
- What general situations are discussed as raising denial or audit risk
- How the article addresses confusion between different modifiers in lab billing
- Which specialties are mentioned in relation to reported claim patterns
Who Should Read This
- Medical coders
- Billing staff
- Compliance staff
- Anesthesia practices
- Pain management practices
- Interventional pain management practices
Codes Discussed
Modifiers Discussed
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