Oncology & Hematology Coding Alert

Question: Our practice billed Medicaid for a patient’s chemotherapy treatment, which was a combination of two drugs with one J code and two national drug codes (NDCs). We used a 76 modifier but received a denial; when we called Medicaid, they told us we had to use KQ modifier instead. I don’t think this is correct, so who is right?

Illinois Subscriber

Answer: In this case, Medicaid is absolutely correct. As its descriptor says, modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) is used to document that a provider has repeated the same procedure or service on the same day. However, chemotherapy drugs on their own are not a procedure or service.

Modifier KQ (Second or subsequent drug of a multiple drug unit dose formulation), however, is specifically designed to alert the payer that the line item to which it is appended is not a duplicate but is subsequent, or second, to a drug listed on a previous line. In your case, this is exactly what happened, which is why the Medicaid determination is correct.