Modifiers The Rest of the Story 2011 Sponsored by: aapc

Repeat clinical diagnostic laboratory test
—This modifier 
identifies a repeated laboratory service. One risk of utiliz-
ing this modifier is using it when an incomplete sample is 
obtained. This modifier identifies that the same test was 
done more than once in the same day and was medically 
necessary and most frequently occurs when a physician 
wants to have comparative results. When this occurs, mod-
ifier 91 must be attached to the additional services. 
For example: A patient has an unusually high glucose in 
the morning and a repeat test is performed later in the 
day to insure that the level is lower. Modifier 91 would be 
attached to the second glucose.
Procedures in the Global Period
Major procedures have a 90 day global period. What this 
really identifies is that nearly all services provided by the 
surgeon in the 90 day global period are included in the 
global surgical package and are not paid separately. All of 
the following services are included in the global surgical 
package, per CMS:
 
y
Preoperative Visits—Afterytheydecisionytoyperformysurgeryy
hasyalreadyybeenymade.yThisybeginsywithytheydayybeforey
majorysurgery.
 
y
Intraoperative services—Servicesythatyareyayusualyandy
necessaryypartyofyaysurgicalyprocedure.
 
y
Complications following surgery—Thoseywhichydoynoty
requireyayreturnytripytoytheyoperatingyroom.
 
y
Postoperative visits—Follow-upyvisitsythatyareyrelatedytoy
normalysurgicalyrecovery.
 
y
Postsurgical pain management—Painymanagementypro-
videdybyytheysurgeon.
 
y
Miscellaneous services—Theseyincludeysupplies,ydress-
ingychanges,yincisionalycare,yremovalyofypacking,yremovaly
ofysuturesyorystaples,yremovalyofylines,ywires,ytubes,ydrains,y
castsyandysplints,yinsertion,yirrigationyandyremovalyofyurinaryy
catheters,yroutineyperipheralyIVylines,ynasogastricyandyrectaly
tubes,yandychangesyoryremovalyofytracheostomyytubes
When services other than those included in the global 
package are performed, and claims are electronically 
adjudicated, the payers’ systems usually treat all services 

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