Otolaryngology Coding Alert

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 Subscriber

Answer: 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 the physician who controlled the nosebleed initially. If she is not in the same practice and works for a different practice/different tax ID, no modifier is needed at all.

Do this: If the second physician is in the same practice as the initial physician, you can first submit your claim with modifier 77, and if it's denied, resubmit a correction or appeal -- if necessary -- with modifier 59 to indicate that the two services were provided to the patient at two different encounters.

Tip: If your physician performs two different procedures, for example 30905 (Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial) and then 30906 (...subsequent), you should not use modifier 77. You then only have the choice to use modifier 59 to indicate that the two procedures were performed at different encounters.