tci Part B Insider - 2011 Issue 29

Reader Question: Modifier 76 Denotes Repeat Procedure

Question: After our physician performed manipulation he performed an x-ray, but he was not happy with the reduction and manipulated again. The post-reduction X-ray was repeated, but our MAC denied the repeat x-ray. What modifier should we have used on it?Answer: You should have appended modifier 76 (Repeat procedure or service by same physician or other qualified health care professional:....) when reporting the second X-ray. Confirm with your payer's guidelines because you may not be paid for the second post-reduction set of films.For example, if your orthopedist does a closed reduction of the elbow by extending...

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