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Question: Our lab performs tests to assess a patient’s ability to produce testosterone after being stimulated by human chorionic gonadotropin (hCG). The test involves taking an initial blood sample to measure the patient’s baseline testosterone levels, administering a dose of testosterone to the patient, then taking three blood samples over the course of several days for a second test to measure the testosterone response. Should I report this as 2 units of 84402 with modifier 91 for the repeat test?

Indiana Subscriber

Answer: Coding 84403 (Testosterone; total) using modifier 91 (Repeat clinical diagnostic laboratory test) would not be the correct way to document this scenario, even though the test you describe does require your lab to perform a total testosterone test, described by 84403, twice as you say.

That’s because there is a different code you should use to describe scenarios such as these: 80414 (Chorionic gonadotropin stimulation panel; testosterone response. This panel must include the following: Testosterone (84403 x 2 on 3 pooled blood samples)). As you can see from the descriptor, the code references 84403 being repeated (x 2) as in your scenario, making 80414 a panel comprised of two total testosterone tests. As both tests are accounted for in the descriptor for 80414, the one code is all you need, and it would be incorrect to append modifier 91.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC