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Posted By angie on 03-04-2019, 11:21:59 in Ob-Gyn
We are having a issue with Preferrred One now asking for a modifier on a claim when billing out 81002 with 87086. It's not every preferred one plan, just one. We have sent them CCI edits, but they are still stating we need a modifier. THoughts?

Comments (2)
Posted By angie on 03-07-2019, 08:18:44
claim examples I sent. 99213, 81002, 87086-90 another was 99213 and 81002 no other labs done. I can't a reason any other modifier would be needed.
Posted By Melanie Witt on 03-06-2019, 16:08:36
While 81002 is a waived test under CLIA guidelines (which means you can perform it in your office), it does not require a QW modifier to get it paid. 87086, on the other hand IS NOT a CLIA-waived test and can only be billed by a lab that has the correct certificate to do so. So my question is, are you sending this test out to be performed by a lab, but are billing on behalf of the lab? If that is the case, you would have to add a modifier -90 to that lab code. I am pretty sure they are not looking for a modifier -59 since there are no bundling issue either with CCI or CPT in reporting these codes together. And also be sure that 87086 is the correct code since 81007 is screening for bacteria via dipstick and might be what you did (and that code does require a QW modifier).
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