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Orthopedic Coding Alert

Modifier of the Month:

Use -76 When One Physician Repeats Procedure,X-Ray Study

Published on Mon Apr 01, 2002

Modifier -76 (Repeat procedure by same physician) is appended when the same procedure (with the same CPT code) is performed twice on the same day by the same physician. Both occurrences of the procedure should be billed on the claim, and documentation on the medical necessity of each occurrence should be provided. This modifier confirms for the payer that you have not reported a procedure twice in error.

The following case study illustrates proper use of modifier -76:

A 65-year-old male patient with dislocation of his total hip prosthesis is brought from home to the emergency department (ED). His orthopedic surgeon performs a closed reduction of the prosthesis. When the patient returns home, he slips getting out of his car and suffers a repeat dislocation. The patient returns to the ED and his orthopedist, who performs another closed reduction. The patient returns home without incident.

  • If the patient did not require general anesthesia, coding for this case would be: 996.4 (Mechanical complication of internal orthopedic device, implant, and graft), 27265 (Closed treatment of post hip arthroplasty dislocation; without anesthesia),27265-76.
  • If the patient is no longer in the postoperative period of the original hip arthroplasty, an E/M code for the visit to the ED can also be reported (e.g., 99284, Emergency department visit for the evaluation and management of a patient ).

    Modifier -76 can also be reported when a physician repeats an x-ray study, as in the following example:

    A patient presents to the orthopedist's office after falling onto her outstretched left hand.The orthopedist x-rays the left wrist in three views (73110, Radiologic examination, wrist; complete, minimum of three views) and diagnoses a fracture of the distal radius (813.41). He treats the fracture with a short arm cast (25600) and repeats the x-ray series after casting to determine that the fracture remains in an acceptable position.

    The second set of x-rays is reported as 73110-76.

    Note: "Modifier of the Month," a new feature of Orthopedic Coding Alert, will examine the application of a different modifier in the orthopedic setting each month.

     

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