by Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
July 31st, 2014
Have you ever had a claim deny as a ‘duplicate service’ only to find out upon further review that it was actually performed twice on the same day? This occurs more often than you realize and it is fairly easy to correct the error and get the claim paid.
Modifiers 76 and 77 are reported when a repeat procedure (the same exact procedure or service) is performed on the same day by either the same physician or another physician.
This occurs quite frequently in radiology so let’s review an example related to that specialty.
Example:
The patient presents for right shoulder pain after falling down the stairs at home. A complete x-ray of the right shoulder was taken demonstrating closed dislocation of the anterior humerus but no fracture was found.
A repeat complete shoulder x-ray was performed, following reduction of the dislocation by the patient’s physician, to verify reduction was successful. It was read by the same radiologist.
Following reduction the provider sent the patient back for a repeat complete x-ray of the shoulder to verify proper reduction.
Coding:
The first x-ray would be coded CPT: 73030-RT and ICD-9: 831.01, 959.2
The second, or repeat x-ray, would be coded CPT: 73030-76-RT and ICD9: 831.01
If the radiologist reading the second x-ray differs from the radiologist who read the first x-ray then modifier -77 would be appended to the second service.
Repeat procedure by the same provider (on the same day) uses modifier 76.
Repeat procedure by a different provider (on the same day) is reported using modifier 77.
Sometimes the insurance company will deny a repeat procedure on the same day, even when you have reported the service with the correct modifier. When this happens, you will need to appeal the duplicate denial by submitting a copy of both x-ray reports and a letter requesting the review to the insurance company. This should clear up any confusion.
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