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CARTA CIRCULAR # M1606074
30 de junio de 2016
A TODOS NUESTROS PROVEEDORES PARTICIPANTES
Modificador 91 vs 59: Pruebas de Laboratorios repetidas con mismo Diagnóstico Clínico
El Current Procedural Terminology CPT®, Edición Profesional, define modificador 91 de la siguiente
manera:
''Repeat Clinical Diagnostic Laboratory Test:
In the course of treatment of the patient, it may be necessary to repeat the same laboratory
test on the same day to obtain subsequent (multiple) test results. Under these circumstances,
the laboratory test performed can be identified by its usual procedure number and the addition
of modifier 91.
Note: This modifier may not be used when tests are rerun to confirm initial results; due to
testing problems with specimens or equipment; or for any other reason when a normal, onetime, reportable result is all that is required. This modifier may not be used when other code
(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression
testing). This modifier may only be used for laboratory test (s) performed more than once on
the same day on the same patient.''
La codificación con modificadores, publicada por la Asociación American Medical (AMA), dice que el
modificador 91 se utiliza para informar la repetición de pruebas clínicas de laboratorio de diagnóstico
realizados en el mismo paciente el mismo día.
Además, afirman que el modificador 91 no debe utilizarse cuando la segunda prueba o muestra de
cultivo es de un sitio diferente. Para este caso el modificador 59 se utiliza en la misma fecha de servicio,
a menos que un segundo cultivo (mismo código CPT) se lleva a cabo en el mismo día en el mismo
sitio.
Los sistemas identifican cuando un modificador 91 ó 59:


Se repite el modificador de manera inapropiada con un mismo procedimiento para la misma
fecha de servicio.
En la revisión de historial de las reclamaciones muestran que no hubo el mismo procedimiento
original facturado para esa fecha de servicio sin modificador.
Cordialmente,
José E. Novoa-Loyola, MD, FACC
Principal Oficial Médico
CIRCULAR LETTER #M1606074
June 30, 2016
TO ALL OUR PARTICIPANTS PROVIDERS
Modifier 91 vs 59: ¨Repeat Clinical Diagnostic Laboratory Test¨
The current CPT® Professional Edition defines modifier 91 as follows:
''Repeat Clinical Diagnostic Laboratory Test:
In the course of treatment of the patient, it may be necessary to repeat the same laboratory
test on the same day to obtain subsequent (multiple) test results. Under these circumstances,
the laboratory test performed can be identified by its usual procedure number and the addition
of modifier 91.
Note: This modifier may not be used when tests are rerun to confirm initial results; due to
testing problems with specimens or equipment; or for any other reason when a normal, onetime, reportable result is all that is required. This modifier may not be used when other code(s)
describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing).
This modifier may only be used for laboratory test(s) performed more than once on the same
day on the same patient.''
Coding with Modifiers, published by the American Medical Association (AMA), which states ''Modifier
91 is used to report repeat clinical diagnostic laboratory tests performed on the same patient on the
same day."
In addition, they also state that ''Modifier 91 should not be used when the second test or culture
specimen is from a different site; modifier 59 is used on the same date of service unless a second
culture (same CPT code) is performed on the same day for the same site.''
The edit system identifies when a:


Repeat modifier has been reported inappropriately with a laboratory service or procedure that
has not been repeated.
Laboratory procedure is submitted with a 59 or 91 modifier, signifying the procedure to be a
repeat of the same procedure done previously during the day, yet review of claim history shows
that there was no original same procedure submitted for that date of service.
Cordially,
José E. Novoa-Loyola, MD, FACC
Chief Medical Officer