AMA CPT® Assistant - 2010 Issue 9 (September)
Use of CPT Modifiers 76, 78, and 79 (September 2010)
September 2010 pages 6-7 Use of CPT Modifiers 76, 78, and 79 This article will provide an overview of CPT modifiers and focus specifically on the definition and use of modifiers 76, 78, and 79. Use of Modifiers CPT modifiers may be reported with a CPT code to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition. Modifiers also enable health care professionals to efficiently respond to payment policy requirements established by other entities. CPT modifiers may be used in many circumstances, including: altered services (eg, prolonged, service greater...
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Article Overview
This article explains how CPT modifiers are used to communicate special circumstances to payers, with emphasis on three commonly referenced modifiers and their application in professional and facility billing contexts. It is intended for coding professionals, billers, and clinicians who need to understand how modifier use relates to claim reporting, postoperative services, and radiology or surgical scenarios. The article also discusses related guidance involving CPT, HCPCS Level II, and modifier use in hospital outpatient and physician services.
Why This Topic Matters
Accurate modifier reporting can affect how claims are processed, help prevent duplicate or denied claims, and support proper communication of service circumstances to payers.
Article Sections
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Use of Modifiers
Introduces the general role of CPT modifiers in reporting services affected by special circumstances. Also notes where modifier lists are found and why careful review of modifier applicability matters.
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Use of Modifier 76
Discusses the modifier focused on repeated services by the same practitioner and includes a billing example. The section also touches on related reporting considerations in radiology and facility settings.
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Use of Modifier 78
Covers the modifier used for certain unplanned postoperative returns involving the same surgeon. An example and related discussion of postoperative period considerations are included.
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Use of Modifier 79
Explains the modifier associated with an unrelated procedure during the postoperative period by the same surgeon. The section includes an illustrative scenario and related timing considerations.
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In summary
Provides a brief closing overview of modifier reporting and points readers to additional reference material.
What You Will Learn
- The general purpose of CPT modifiers in claim reporting
- How the article frames the use of three specific modifiers
- The types of circumstances that can affect modifier reporting
- How modifier use is discussed across physician and facility settings
- Where to look for broader modifier reference information
Who Should Read This
- Medical coders
- Billing staff
- Physicians and other practitioners
- Hospital outpatient and facility coding staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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