# modifier 76 with an ED E/M code



## WATSONC (Mar 31, 2010)

Can modifier 76 be used with an ED E/M code if the same ER doctor saw a patient twice in the same day?

Thanks!


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## mitchellde (Mar 31, 2010)

76 is not allowed on E&M codes.  If you are billing for the facility you will append a 27 modifier if you are billing for the physician you will combine the elements of both visits and bill one E&M.


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## WATSONC (Apr 1, 2010)

The reason I am asking is because I am being advised to use it on the ED E/M code due to the description of the code which states that the -76 modifier is to be used "when a physician performs a SERVICE or procedure,and the same physician has to repeat the exact same SERVICE or procedure during the global period.  This modifier should be used when coding for a repeated procedure on the claim by the same physician, same day, however, it does not need to be on the same day, nor is it limited to minor procedures."   I am being told that since it states "service" then it can be used on an E/M code even though the last part of the description only states "procedure".


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## mitchellde (Apr 1, 2010)

The 76 is for when you repeat the service/procedure not just the code.  You cannot use it on E&M because this is a service that is not repeated.  If the patient comes in a second time then everything must be done exactly the same way as the first time same questions, same problem addressed, identical in every way including the plan of care and while this might be a case where both were a level 3 there is going to be some measure of difference so the same service was not repeated.  For multiple E&Ms on the same day we have always been told to roll the elements together and bill one code.


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## twosmek (Apr 2, 2010)

I agree with Deb. The only other modifier that you may be able to use in 24 but as she said you can only charge 1 E&M code per day per physician for the same patient.


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## WATSONC (Apr 5, 2010)

*76 Modifier with E/M codes*

Thank you for the information about the 76 modifier.  However, I have never heard that if a patient saw the same ER doctor twice in the same day, the two visits have to be combined and only bill for one visit.  Where is that documented?  It seems like to me that if a patient has to come back to the ER and the doctor has to provide services both time, he should be able to charge for both visits.


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## twosmek (Apr 8, 2010)

is it for the same thing or something different? If it is for something different and a new evaluation and treatment is done. I do believe that you can charge a new E&M code with the 24 modifier. Of course you would need to have different dx for the 2nd visit than the first.  I am not sure-that is my thought anyway. I don't do much ER coding and have never ran into that before.


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## RebeccaWoodward* (Apr 8, 2010)

WATSONC said:


> Thank you for the information about the 76 modifier.  However, I have never heard that if a patient saw the same ER doctor twice in the same day, the two visits have to be combined and only bill for one visit.  Where is that documented?  It seems like to me that if a patient has to come back to the ER and the doctor has to provide services both time, he should be able to charge for both visits.



*Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems*

As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident).

http://www.cms.gov/manuals/downloads/clm104c12.pdf

Page 43


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