ED Coding & Reimbursement Alert - 2013 Issue 24
How to Use Modifiers 76 and 77 to Your Advantage
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Article Overview
This article is a coding guidance piece for practices, billers, and coders who need a clearer understanding of repeat-service modifier usage in common outpatient scenarios. It focuses on general Medicare contractor policy considerations, repeat procedures performed by same or different physicians in the same practice, and repeat laboratory testing guidance under CPT-related reporting conventions.
Why This Topic Matters
Correct handling of repeat-service and repeat-test reporting can help practices avoid duplicate-service billing issues and align claims with payer expectations.
Article Sections
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Introduction
Introduces the topic of duplicate-service billing concerns and the role of repeat procedure modifiers in preventing reporting errors.
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Modifier 77 Applies for Exact Same Procedure
Covers same-day repeat procedures performed by different physicians in the same practice and notes payer policy considerations.
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Look to Modifier 76 When the Same Physician Does Both Procedures
Addresses repeat procedures performed by the same physician on the same date and contrasts this scenario with the prior section.
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Consider Modifier 91 for Repeat Labs
Discusses repeat laboratory testing and identifies that this area is treated differently from repeat procedure reporting.
What You Will Learn
- How repeat-service reporting is discussed for same-day encounters
- How payer policy can affect repeat-procedure reporting
- How repeat laboratory testing is treated differently from repeat procedures
- What types of scenarios the article uses to illustrate repeat-service modifier use
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Physician practices
- Compliance staff
Codes Discussed
Modifiers Discussed
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