Medicare Compliance & Reimbursement

Note: Modifier 59 won't apply to situations when the physician performs the exact same procedure twice. Question: Is modifier 76 or 59 appropriate when the radiologist reviews two studies on the same date of service, but the scans don't merit the same codes? Answer: Unless your payer tells you differently, use modifiers 76 (Repeat procedure or service by same physician or other qualified health care professional) and 77 (Repeat procedure or service by another physician or other qualified health care professional) only when the provider(s) perform the exact same exam twice. Example 1: If a patient in the intensive care unit has two single-view chest X-rays (71010, Radiologic examination, chest; single view, frontal) on the same day, report the second exam with modifier 76 or 77 (depending on whether both exams involved the same physician). Example 2: If a patient has a complete ankle exam (73610, Radiologic examination, ankle; complete, [...]