Laboratory Question for the Week of May 1, 2017

Question:

Does CMS allow modifier 91 with the NCCI PTP edits?

Answer:

Yes, modifier 91 is among those modifiers allowed with the National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits.

As explained by the Centers for Medicare & Medicaid Services (CMS), modifier 91 may be appended to laboratory procedure(s) or service(s) to indicate a repeat test or procedure on the same day when appropriate. This modifier indicates to the Medicare contractors that the physician had to perform a repeat clinical diagnostic laboratory test that was distinct or separate from a lab panel or other lab services performed on the same day, and was performed to obtain medically necessary subsequent reportable test values. This modifier must not be used to report repeat laboratory testing due to laboratory errors, quality control, or confirmation of results.