Question:

What must documentation show if appending a modifier to bill multiple CPT® codes that represent analysis performed on a single specimen?

Answer:

Included in this NCCI update is guidance regarding separate billing of full gene sequence analysis and duplication/deletion analysis, stating that in general the two procedures would not be separately billed. If appending a modifier to bill multiple CPT codes that represent analysis performed on a single specimen, documentation in the medical record should clearly show physician determination of genetic analysis to be performed, the sequence in which testing was performed, a medical indication that links the multiple CPT codes to test results, and the diagnosis code that represents medical problems being managed by the ordering provider.

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