HCPro, JustCoding Outpatient - 2016 Issue 24 (June)
Q&A: Using modifier -91 with laboratory test edits
June 21st, 2016
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Article Overview
This Q&A explains a laboratory coding scenario involving repeated tests on the same date of service and the presence of an NCCI edit between two CPT laboratory panel codes. It summarizes the general Medicare and NCCI guidance relevant to repeat diagnostic testing, duplicate lab claims, and use of modifier -91. The article is aimed at coders, billers, compliance staff, and other professionals who work with laboratory billing and NCCI edits.
Why This Topic Matters
Laboratory claims often trigger edit checks when similar tests are repeated the same day, so understanding the scope of Medicare and NCCI guidance helps reduce denials and support compliant reporting. The article is relevant to anyone reviewing repeated lab testing, panel edits, and modifier usage in outpatient or physician-based billing workflows.
What You Will Learn
- How same-day repeated laboratory testing is discussed in relation to NCCI edits
- How Medicare guidance is referenced for duplicate laboratory claims
- What general considerations are highlighted for reporting repeat diagnostic testing
- How the article frames the role of modifier -91 in repeat lab scenarios
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Laboratory billing specialists
- Physician practice revenue cycle staff
Codes Discussed
Modifiers Discussed
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