# modifier 76 usage



## Pillow1 (Jan 12, 2010)

Would you use 76 modifiers on the 2nd procedures?
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PROCEDURE 1

PROCEDURE DIAGNOSIS: 
Angina. 

POSTPROCEDURE DIAGNOSIS: 
Severe obstructive coronary artery disease. 

OPERATION PROCEDURE: 
1. Left ventriculogram. 
2. Coronary angiogram. 
3. Left subclavian angiogram. 
4. Left heart catheterization. 
5. PTCI of the SVG to the PDA. 
6. PTCI x2 of the SVG to the OM 1. 
7. PTCA x2 to the proximal and mid circumflex. 


FINDINGS: 
1. Occluded SVG to the ramus. 
2. Patent LIMA to the LAD. 
3. Occluded LAD and RCA disease. 

4. A 75% mid body lesion in the SVG to the PDA that was 
successfully stented with a drug-eluting stent. 
5. SVG to the OM with 2 lesions, 90% at mid body and 80% in the 
distal anastomosis, both stented with drug-eluting stents. 
6. A 90% proximal circumflex and 75% mid circumflex. Both 
lesions successfully ballooned. 
7. Normal left ventricular function with an EF of 60%. 

COMPLICATIONS: 
Please see next dictation regarding dissection and thrombus formation 
in the vein graft. 

WE BILLED THIS FIRST PROCEDURE AS SUCH AND RECEIVED PAYMENT ON ALL OF THE BELOW CODES

93510
36215-59
93543
75685-2659
93545
92980-RC
93555-2659
92981-LC
93556-2659


*******PROCEDURE 2 DONE ON THE SAME DAY***


Acute stent thrombosis. 

POSTPROCEDURE DIAGNOSES: 
1. Dissection and thrombosis of the proximal SVG to the OM 1. 
2. Distal edge dissection of the mid SVG to the PDA stent. 

OPERATIVE PROCEDURES: 
1. IVUS of the SVG to the OM 1. 
2. Coronary angiogram. 
3. PTCI x2 to the SVG to the OM 1. 
4. Thrombectomy of the SVG to the OM 1. 
5. IVUS of the SVG to the PDA. 
6. PTCI of the SVG to the PDA. 
ANESTHESIA: 
IV Versed and fentanyl with local lidocaine. 



FINDINGS: 
1. Dissection with subtotal occlusion of the ostial and 
proximal body of the SVG to the OM with thrombus, requiring 
thrombectomy and 2 drug-eluting stents. 
2. A 75% distal edge dissection of the SVG to the PDA mid body 
distal to the prior stent requiring a second stent Promus 3.0 x18. 
3. Patent circumflex. 

****WE CODED/BILLED THE FOLLOWING CODES FOR PROCEDURE 2 SAME DAY BUT BLUE CROSS DENIED SOME CODES*

92980 LC 76 DENIED
92981-RC76 PAID
93508-26 DENIED
93545 DENIED 
93556-2659 DENIED
92978-2659 PAID
92979-2659 PAID

***THANK YOU FOR TAKING THE TIME TO READ ! **** 
__________________
Denise 

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