tci Medicare Compliance & Reimbursement - 2014 Issue 24
Reader Question: Ask Payer Preference for Modifier 91 vs. 59
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Article Overview
This reader-question article explains a common laboratory billing scenario involving repeat testing tied to an initial panel and highlights that payer preferences may differ for how the repeat service is reported. It is relevant to laboratory coders, billing staff, and compliance teams who need to understand the broad documentation and payer-guidance issues involved in same-day repeat testing.
Why This Topic Matters
Same-day repeat laboratory testing can raise payer-specific reporting questions and potential bundling concerns, so correct handling depends on understanding the applicable guidance and the payer’s preference. The article helps readers recognize when they may need to confirm reporting expectations before submitting a claim.
Article Sections
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Question
Presents a laboratory billing question involving a same-day repeat test after an abnormal finding.
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Answer
Summarizes the general reporting concern and notes that payer direction may affect how the repeat service is reported.
What You Will Learn
- How repeat same-day laboratory testing may be discussed in relation to an initial panel
- Why payer preferences can matter in laboratory reporting
- What types of guidance may be needed before billing a repeat test
- How payer-specific direction can affect reporting choices
Who Should Read This
- Laboratory coders
- Medical billers
- Revenue cycle staff
- Compliance staff
- Practice managers
Codes Discussed
Modifiers Discussed
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