ED Coding and Reimbursement Alert

Question: The ED physician performed a successful reduction on a patient's hip, and 11 days later the patient returned to the ED with a dislocated hip again. The doctor again performed a reduction. The insurer is denying the claim because of the 90-day global period. Should I try reporting it again with modifier -76 or modifier -77?


Kansas Subscriber


Answer: In this case, you best option is to query the payer in question directly, because your emergency department physician performed a very necessary repeat procedure.

While modifier -76 (Repeat procedure by same physician) and modifier -77 (Repeat procedure by another physician) are possibilities, you should also consider whether appending modifiers -78 (Return to the operating room for a related procedure during the postoperative period) or -79 (Unrelated procedure or service by the same physician during the postoperative period) are appropriate, because these modifiers reference additional procedures during the postoperative period.