Oncology & Hematology Coding Alert
Hesitate Before Appending Modifier 76 to J9999
Question: We bill for medical oncology and use multiple dose forms of chemotherapy drugs to reach the patient's necessary dose. This involves multiple National Drug Codes (NDCs) that we must report separately. My question is, should we use modifier 76? Scenario: J9999 (1st NDC number reported) 400mg New Mexico Subscriber Answer: Ask yourself why you are applying modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional). You should append this modifier when a physician performs a repeated procedure, and in this circumstance, you are not performing an additional procedure. You are simply dividing the supply (medication) out for billing purposes, based on the NDC number. Heads up: You should also check with the payor. It is possible that you can list multiple NDC codes to one line item to distinguish the different vials sizes used to provide the total dose administered to the patient.
J9999-76 (2nd NDC number reported) 200mg
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