This is an older post on my blog, but I figure it's worth sharing here because it's one of the most-read posts that I've written :)
For this week, I thought I’d talk about 2 common modifiers used in diagnostic radiology–modifier 76 and 77. Let’s be honest though–talking about modifiers is probably not the most exciting coding thing to talk about–but it’s important. I’ll do my best to explain it in such a way that you actually read the whole article without getting bored–
So–modifier 76. If you look at the CPT book it says-
Ok, so the keywords here are ‘Repeat Procedure’ and ‘Same Physician.”
Now let’s look at modifier 77:
The keywords to look at here are ‘Repeat Procedure‘ by “Another Physician.’
So the difference between these modifiers is that modifier 76 is for a repeat procedure by the same physician on the same day, and modifier 77 is for a repeat procedure by a different physician on the same day.
In diagnostic radiology, I would say these modifiers are most commonly used on x-rays. Sometimes the same patient might need the same x-ray taken a few times during the course of the day. It could be x-rays for broken bones or chest x-rays to monitor different issues over time.
Le’ts look at a very common code- 71045. This is the CPT code for a 1 view chest x-ray.
Say if a patient had:
A 71045 was done at 8 am- read by Dr Smith, then later the same day
A 71045- done at 2 pm- read by Dr Smith
So basically this patient had 71045 done twice the same day. To bill these out, you have to add a modifier. In this case, this is the same procedure, read by the same physician. What modifier would you use?
You would add a modifier 76 to show that it’s a repeat CPT read by same radiologist. The 76 would go on the 71045 billed at 2 pm.
Let’s look at another example:
Say if a patient had:
71045 done at 9 am, read by Dr Smith, then later the same day
71045 done at 2 pm ready by Dr Jones
Now which modifier would you use? You would use a modifier 77 to show that this patient had 2 separate 71045’s done the same day, but NOT read by the same dr. You would add a modifier 77 on the 71045 from 2 pm. Does this make sense? You would use these modifiers to bill out 2 separate 71045’s the same day. You’re just trying to tell the insurance company if the same radiologist read the films or not. If you forget to add these modifiers, the insurance company most likely will think you made a mistake and billed out the same exam twice and deny one.
**Just a reminder–always follow client specific guidelines and insurance specific guidelines.
Questions? Feel free to comment below or email me at mightmedicalcoding@gmail.com.
