Q&A: Reporting a repeat laboratory test as a distinct service using CPT codes
Q: A physician orders a comprehensive metabolic panel (CPT code 80053) and an additional quantitative blood sample to measure blood glucose level (CPT code 82947). Would the physician report modifier -91 (repeat clinical diagnostic laboratory test) or -59 (distinct procedural service) to indicate that the blood sample was performed separately from the panel?
A: The physician should report CPT code 80053 for the panel and code 82947 for the additional blood sample with modifier -91. The modifier -91 is necessary to distinguish the additional blood sample from the laboratory panel, since a single blood sample to measure blood glucose level is a component of the comprehensive metabolic panel.
Chapter 10 of the NCCI Manual contains edits that pair CPT codes for laboratory panels (Column One codes) with codes for the individual laboratory tests included in the panels (Column Two codes). These edits may be bypassed by appending an applicable NCCI-associated modifier to the CPT code for the repeat laboratory test performed on the same date as a panel. According to CMS, modifier -91 may be utilized to identify the same test repeated on the same day or a test that is a component of a panel being repeated on the same day.
Providers will only be reimbursed for repeat testing services that are medically reasonable and necessary. Per the Medicare Claims Processing Manual, Chapter 16, section 100.5.1, repeat testing cannot be performed to “confirm initial results; due to testing problems with specimens and equipment or for any other reason when a normal, one-time, reportable result is all that is required.”
Editor’s note: Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, CPAR, CPC, COC, and Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, answered this question during the HCPro webinar, “2019 Modifier Update: Review New NCCI Guidance.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.