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Billing Correctly for Urine Drug Screen

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RichardP:
An example I've seen for the appropriate use of Modifier 91 is a situation where the person was tested for drugs early in the day and the results were within expected limits.  Later that same day, the same person is brought in in obvious medical distress.  The second test is allowed to discover whether the patient is having a reaction to any of the drugs tested for in the first test - drugs that would have been ingested after the first test.

Here is another situation - not tied directly to urine drug testing - but it provides perspective:

A patient with high blood pressure who has been on a low-salt diet may receive a plasma renin activity (PRA) test (84244 Renin) in the morning in the supine position. Because physicians may use variations in PRA levels due to time of day and patient position to evaluate certain conditions such as hyperaldosteronism they may order a repeat renin in the afternoon with the patient standing upright for a period of time.

Coding example:
84244
84244 – 91

Report the second 84244 with modifier -91 to indicate that the lab performed two separate renin assays for the same patient on the same day.

From here:
http://www.poweryourpractice.com/revenue-cycle-management/modifier-59-25-91-guide-coders/

If you Google on "modifier 91 vs 59" you can find some useful conversations.

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