You Be the Coder:
Play It Safe By Billing Repeated Nosebleed Procedure With Modifier 59
Published on Tue Aug 02, 2011
Question: My physician saw a patient at the hospital for a nosebleed. Later that day, another physician saw the same patient in emergency for severe nosebleed. She spent an hour to get the nosebleed under control. Should I use modifier 77 to bill both doctors?Tennessee SubscriberAnswer: No. In theory, modifier 77 (Repeat procedure or services by another physician or other qualified health care professional) may be correct if the exact same CPT® is repeated. However, most payers do not pay non-diagnostic procedures limited to the 7xxxx and 8xxxx sections of the CPT® manual with the 76 and 77 modifiers.In the case of the procedure in question, 30903 (Controlnasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method), the only way to get it paid with most payers is by appending modifier 59 (Distinct procedural service). Based on your question, I assume the second doctor is in the same practice as [...]
