76 Modifier : Coding Guidelines for coders

Table of Contents

Basics about 76 modifier

As per my knowledge and experience, Modifiers play a very important role in Medical coding. Modifiers are very used when there is a modification in the procedure performed. Modifiers are very important for Clearing CPC certification exam as well. There will at least one question about 76 Modifier, Modifier 59 and other modifiers. It is one of the most commonly used modifier in outpatient setting.

Modifier 76 is used for the procedure which are repeated on same day by same physician. This looks very easy to learn but while coding charts you have to be careful.

We will just learn first Modifier 76 description and then how it can be used in CPT coding. It is used when it is necessary to report a procedure repeated subsequent to the original procedure when the same physician performs the services.

Use of Modifier 76 in Outpatient setting

From last few years, I am using Modifier 76 very frequently. Since I am a coder of Radiology facility, I come across this modifier everyday. There are many procedures, which are repeated, and we tend to use this modifier in such cases.

For example if we have a patient coming for flank pain and the physician performs Retroperitoneal ultrasound complete 76770 for flank pain and again the patient comes same day to same physician with renal problem and again the physician perform Retroperitoneal ultrasound complete 76770. Now, in such cases we have to use 76 with CPT code 76770 when same physician repeats the procedure on same day.

Another example from Interventional radiology, suppose a patient comes with chest pain in morning and physician perform one view of chest x ray 71045. Now, in afternoon the same patient come to physician and the physician places a central venous catheter tunneled 36561 in chest.

After placing the central venous catheter physician again perform a chest x-ray 71045 to check proper placement of catheter, then this chest x-ray exam is coded with Modifier 76.

If we don’t assign 76, the insurance companies will think the exam is duplicated to increase the dollar value, hence 76 is used to get payment for both chest x-ray.

Now, if you are very much clear with that I will create a little confusion here. Do not code 76 whenever you see same CPT code because sometimes the procedures will be performed on different parts of the body but the code will be same.

Do not use 76 Modifier to same CPT codes

As I have told you, Modifier 76 can be used only when the same procedure is performed same day. However, in Medical coding we give same CPT codes even for different procedure. We have limited CPT codes so there are few CPT codes used again if a same kind of procedure is performed but on different anatomic location.

For example, CPT code 93970 and 93971 are the best example for above scenario. When Duplex ultrasound is performed on vein of bilateral lower extremity we assign 93970 CPT code and for bilateral upper extremity as well 93970. Therefore, in such scenario we cannot use 76. Here we will assign modifier 59 or XS, because there is difference in anatomic structure and location. Hope you would have got a clear idea about Modifier 76. It is easy to apply if you have gain sufficient experience in coding.

76 Modifier is used to report a service or procedure that was repeated by the same practitioner subsequent to the original service or procedure. The use of Modifier 76 is restricted to only few CPT codes.

Modifier 76 is applicable to code ranges 10021-69990, 70010-79999, 90281-99199, and 99500-99607. For duplicate procedure in this code range, CPT code should be assigned with modifier 76 for proper reimbursement.

Inappropriate Uses

Adding to each line of service
Adding to a surgical procedure code;
Staged procedures (modifier 58),
Unplanned return to operating room report modifier 78
Unrelated procedure or service report modifier 79.
Repeat services due to equipment / technical failure
Repeat laboratory services; refer to CPT (Current Procedural Terminology) modifier 91
Services repeated for quality control purposes
A service or procedure was provided more than once; unusual events occurred
Do not report this modifier with ‘add-on’ codes denoted in CPT with a “+” sign. If a service defined as an ‘add-on’ code is repeated or provided more than once (based on description) on the same day by the same provider, report the ‘add-on’ code on one line with a multiplier in the unit field to indicate how many times that service was performed.

Do not assign modifier 76 with laboratory or pathology codes. Use 91 modifier for these procedures.

Do not use 76 modifier with E/M service

Note: You may report this modifier for services ordered by physicians but performed by technicians. “Report modifier -76 or -77 based on whether the physician who performs-not orders-the service is the same or different physician that performed the procedure on the same calendar date of service

Some providers experience denials when using a 76 modifier on more than one line of service to indicate multiple procedures billed on the same date of service by the same physician for the same beneficiary.

For example: When a Ultrasound abdomen (CPT code 76700) is done twice in a day by the same physicican and it will billed three times with 76 , then the third CPT code will be considered as duplicated claim and will be denied.

76700 Paid

76700-76 Paid

76700-76 Denied as duplicated claim

Difference between Modifier 76 and 91

Modifier 91 is used only with the laboratory procedure. The repeat lab procedures should be assigned with modifier 91. It is applicable to code range 80047- 89398. For repeat laboratory tests or studies performed on the same day on the same patient, the CPT code should be assigned with modifier 91.

Do not use modifier 76 for duplicate procedure in this range.

Don’t confuse between Modifier 76 and 77

Their is very little difference between 76 and 77 modifier. Just go through the description for both modifiers below.

Modifier 76 – Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

Modifier 77 – Repeat Procedure by Another (different) Physician or Other Qualified Health Care Professional

So, always check the physician before assigning 76 and 77 modifier. If the same physician repeat the procedure, use 76 and when different physician repeat the procedure same day, use modifier 77.

Hope, now you will be able to code 76, 77 and 59 modifier confidently along with procedure codes. Do share the article if you liked it and share your thoughts about these modifiers in the comment section.

References:

http://www.hcpro.com/HOM-52670-1733/Learn-how-to-use-repeat-procedure-modifiers-76-77-with-this-quiz.html

https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/