Health Information Management

Q&A: Append appropriate modifiers when reporting CPT codes 81002 and 82270

JustCoding News: Inpatient, September 16, 2009

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QUESTION: We receive denials from Medicare for CPT code 81002 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy) and CPT code 82270 (Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening). The remittance code indicates that we must submit a modifier; however, we cannot determine the appropriate modifier to report. Can you provide any advice?

ANSWER: When the physician’s office performs this test in-house, modifier -92 (Alternative laboratory platform testing) may be applicable. HCPCS modifier -QW (Clinical Laboratory Improvement Act waived test) may also apply.

When the physician’s office employs an outside laboratory to perform the tests, report modifier -90 (Reference [outside] laboratory).

If this is not the first time the tests are being performed and reported for a particular patient, append modifier -91 (Repeat clinical diagnostic laboratory test).

When these tests are provided as part of a general colorectal cancer screening (in conjunction with codes G0104, G0105, G0106, G0120, G0121, or G0122), the payer may request that you report modifier -51 (Multiple procedures) or modifier -59 (Distinct procedural service).

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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