Modifier 76: Represents a repeat procedure by the same physician on the same
day.
As per Medicare
when two physicians in the same group with the same speciality performing repeat
services on the same day are considered as the same physician. Then we have to
append modifier 76 with the subsequent repeat procedure within the same day.
Same Physician Eg: When a physician order 2 views of chest x-ray at 10 am and due
to medical necessity he orders for another 2 views of chest x-ray at 11 am on
the same day, then it’s must append modifier 76 with the subsequent repeat
procedure code. Stating that it’s the same procedure repeated by the same physician
DOS: 1/1/2019
Both chest X- rays were ordered by the same physician.
10
am 71046
11
am 71046 – 76
Same speciality physicians Eg: When a physician (A)
order 2 views of chest x-ray at 10 am and due to medical necessity another
physician (B) order for another 2 views of chest x-ray at 11 am on the same day
both the physician belongs to the same speciality, Even though we have to
use modifier 76 with the subsequent repeat procedure code. Stating that
it’s the same procedure repeated by the same physician as per Medicare guidelines.
The number of
times that the procedure was repeated on the same day would be reported with
appropriate modifiers on separate line items.
Eg: When a
physician (A) order 2 views of chest x-ray at 10 am and due to medical
necessity he orders for another 2 views of chest x-ray at 11 am and 12 pm on the same day, append modifier 76 with the subsequent repeat procedure codes.
DOS: 1/1/2019 all
the 3 chest X- rays were ordered by the same physician.
10
am 71046
11
am 71046 – 76
12
pm 71046 – 76
Note:
It’s
inappropriate to use modifier 76 with any Lab codes, for repeat laboratory test
within the same day - Use modifier 91 instead of 76.
It’s
inappropriate to use modifier 76 with subsequent repeat procedure due to
technical fault or equipment issue.
It’s
inappropriate to use modifier 76 with subsequent repeat procedure but at
different anatomic site (Right & Left or upper & lower part), use
modifier 59.
Eg: 93970
– upper extremity and lower extremity duplex scan of vein performed on the same
day at different sessions. It’s more appropriate to use modifier 59 instead of
modifier 76
Modifier 77: Represents a repeat procedure by the different physician on the same
day.
Eg: When a
physician (A) order 2 views of chest x-ray at 10 am and due to medical
necessity another physician (B) belongs to another speciality order for another
2 views of chest x-ray at 11 am on the same day, then it’s must append
modifier 77 with the subsequent repeat procedure code. Stating that it’s same
procedure repeated by another physician.
Note:
Physicians belong to same group speciality have to be considered as same
physician and have to use modifier 76 instead of 77.
Eg: When a
physician (A) order 2 views of chest x-ray at 10 am and due to medical
necessity he order for another 2 views of chest x-ray at 11 am and different
physician (B) order at 12 pm on the same day,
DOS: 1/1/2019 First
2 chest X- rays were ordered by the same physician and the 3rd one was
ordered by a different physician not belongs to the same speciality.
Physician
(A) 10
am 71046
Physician
(A) 11
am 71046 – 76
Physician
(B) 12
pm 71046 – 77
Eg: When a physician
(A) order 2 views of chest x-ray at 10 am and due to medical necessity he orders
for another 2 views of chest x-ray at 11 am and different physician (B) order 2
views of chest x-ray at 12 pm and 4 pm on the same day,
DOS: 1/1/2019 First
2 chest X- rays were ordered by the same physician and 3rd and 4th chest
rays were ordered by a different physician not belongs to the same speciality on the
same day.
Physician
(A) 10
am 71046
Physician
(A) 11
am 71046 – 76
Physician
(B) 12
pm 71046 – 77
Physician
(B) 04
pm 71046 – 77
Note: For each additional time the procedure was performed, the
code is repeated with Modifier 77 added. Do not use the ‘units’ field to
indicate that the procedure was performed more than once on the same day.