76 Modifier Used To Report Same Service On Same Day?

Basics about 76 modifier

As per my knowledge and experience, Modifiers play a very of import role in Medical coding. Modifiers are very used when at that place is a modification in the procedure performed. Modifiers are very important for Clearing CPC certification examination as well. There will at to the lowest degree one question virtually 76 Modifier, Modifier 59 and other modifiers. Information technology is one of the almost commonly used modifier in outpatient setting.

Modifier 76 is used for the procedure which are repeated on same twenty-four hour period by same physician. This looks very like shooting fish in a barrel to learn but while coding charts you have to be careful.

We will but acquire first Modifier 76 clarification and and then how it can be used in CPT coding. It is used when information technology is necessary to written report a process repeated subsequent to the original procedure when the same physician performs the services.

Apply of Modifier 76 in Outpatient setting

From final few years, I am using Modifier 76 very frequently. Since I am a coder of Radiology facility, I come across this modifier everyday. There are many procedures, which are repeated, and we tend to utilize this modifier in such cases.

For example if nosotros take a patient coming for flank pain and the dr. performs Retroperitoneal ultrasound complete 76770 for flank hurting and over again the patient comes same twenty-four hour period to same physician with renal trouble and again the physician perform Retroperitoneal ultrasound complete 76770. Now, in such cases we have to utilise 76 with CPT lawmaking 76770 when same doc repeats the procedure on same 24-hour interval.

Another instance from Interventional radiology, suppose a patient comes with chest hurting in morning and physician perform ane view of chest 10 ray 71010. Now, in afternoon the same patient come up to doc and the physician places a central venous catheter tunneled 36561 in chest.

After placing the central venous catheter physician again perform a chest x-ray 71010 to check proper placement of catheter, then this breast x-ray exam is coded with Modifier 76.

If we don't assign 76, the insurance companies will recollect the test is duplicated to increase the dollar value, hence 76 is used to get payment for both chest 10-ray.

At present, if you are very much clear with that I will create a fiddling confusion here. Do not code 76 whenever you see aforementioned CPT code because sometimes the procedures will be performed on unlike parts of the body but the code volition be aforementioned.

Read besides: How to get perfect in using Modifier 25 and 27

Do not use 76 Modifier to aforementioned CPT codes

As I have told you, Modifier 76 can be used merely when the same procedure is performed same mean solar day. However, in Medical coding we give same CPT codes even for different procedure. We take express CPT codes so there are few CPT codes used once again if a aforementioned kind of procedure is performed but on different anatomic location.

For example, CPT code 93970 and 93971 are the best example for above scenario. When Duplex ultrasound is performed on vein of bilateral lower extremity we assign 93970 CPT code and for bilateral upper extremity every bit well 93970. Therefore, in such scenario we cannot use 76. Here we will assign modifier 59 or XS, considering in that location is difference in anatomic structure and location. Hope you lot would accept got a clear thought about Modifier 76. It is easy to apply if you lot have gain sufficient feel in coding.

Read also: When to utilise Modifier 58 and 78 in medical coding

76 Modifier is used to written report a service or procedure that was repeated by the same practitioner subsequent to the original service or procedure. The employ of Modifier 76 is restricted to just few CPT codes.

Modifier 76 is applicative to lawmaking ranges 10021-69990, 70010-79999, 90281-99199, and 99500-99607. For indistinguishable procedure in this code range, CPT lawmaking should exist assigned with modifier 76 for proper reimbursement.

Adding to each line of service
Adding to a surgical procedure code;
Staged procedures (modifier 58),
Unplanned return to operating room report modifier 78
Unrelated procedure or service study modifier 79.
Repeat services due to equipment / technical failure
Repeat laboratory services; refer to CPT (Electric current Procedural Terminology) modifier 91
Services repeated for quality command purposes
A service or procedure was provided more than in one case; unusual events occurred
Do not report this modifier with 'add-on' codes denoted in CPT with a "+" sign. If a service defined as an 'add-on' lawmaking is repeated or provided more once (based on clarification) on the aforementioned mean solar day by the same provider, report the 'add-on' code on one line with a multiplier in the unit field to indicate how many times that service was performed.

Do not assign modifier 76 with laboratory or pathology codes. Apply 91 modifier for these procedures.

Do non use 76 modifier with E/Thousand service

Note: You may study this modifier for services ordered by physicians just performed past technicians. "Report modifier -76 or -77 based on whether the doctor who performs-non orders-the service is the aforementioned or different physician that performed the procedure on the aforementioned agenda date of service

Some providers experience denials when using a 76 modifier on more one line of service to indicate multiple procedures billed on the same date of service by the same physician for the same beneficiary.

For example: When a Ultrasound abdomen (CPT code 76700) is done twice in a solar day by the aforementioned physicican and information technology will billed 3 times with 76 , then the third CPT code will be considered as duplicated merits and will be denied.

76700 Paid

76700-76 Paid

76700-76 Denied every bit duplicated merits

Read also: New ICD 10 coding guideline for Z3A category in 2018

Difference between Modifier 76 and 91

Modifier 91 is used but with the laboratory procedure. The repeat lab procedures should be assigned with modifier 91. Information technology is applicative to code range 80047- 89398. For repeat laboratory tests or studies performed on the aforementioned day on the aforementioned patient, the CPT code should be assigned with modifier 91.

Practise not employ modifier 76 for duplicate procedure in this range.

Read also: Coding tips for modifier 32 and 33

Don't misfile between Modifier 76 and 77

Their is very little difference between 76 and 77 modifier. Simply go through the clarification for both modifiers below.

Modifier 76 – Repeat Procedure or Service by Aforementioned Md or Other Qualified Health Care Professional

Modifier 77 – Echo Process by Another (unlike) Physician or Other Qualified Health Care Professional

So, always check the medico before assigning 76 and 77 modifier . If the aforementioned physician echo the procedure, utilize 76 and when unlike physician repeat the process same 24-hour interval, utilize modifier 77.

Hope, now you will be able to code 76, 77 and 59 modifier confidently along with procedure codes. Do share the article if you liked it and share your thoughts about these modifiers in the comment section.

References:

http://www.hcpro.com/HOM-52670-1733/Learn-how-to-use-repeat-procedure-modifiers-76-77-with-this-quiz.html

https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resource/