Medicare Compliance & Reimbursement - 2015 Issue 2
You Be the Coder: Know When to Use Modifier 59 and Modifier 91
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Article Overview
This Q&A-style article addresses how billing departments and payers may view modifier use for repeated laboratory testing, with emphasis on distinguishing general separate-service reporting from repeat clinical diagnostic lab testing. It also notes that payer guidance can vary and references related modifier updates for greater specificity. The article is useful for billing staff, coders, and compliance teams working with laboratory claims and payer-specific policies.
Why This Topic Matters
Correct modifier reporting can affect claim acceptance, payment, and compliance for laboratory services, especially when a test is repeated or when services need to be distinguished on the same date of service.
What You Will Learn
- How the article frames the difference between two commonly used modifiers in laboratory billing.
- Why payer-specific guidance may affect modifier selection.
- What general documentation themes are associated with reporting a service as separate or repeated.
- How the article situates newer modifier specificity changes alongside established billing practices.
Who Should Read This
- Medical coders
- Billing staff
- Compliance personnel
- Laboratory billing teams
- Practice managers
Modifiers Discussed
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