Pediatric Coding Alert

Question: A patient reported to our office with bacterial pneumonia, and our pediatrician decided to administer two shots of Rocephin. Whenever we administer more than one injection during the same visit, we have been using modifier 76, but our new office manager is telling us that this is not correct. Is this true, and, if so, what is the correct way to document multiple shots?

Michigan Subscriber

Answer: Typically, you would not use modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) in this situation unless the patient's circumstances change between the times that your provider administers the shots. For example, if your pediatrician administers an epistaxis in the morning to a patient with a nosebleed, and the patient then reports back to your practice later in the day with another nosebleed, you could use the modifier when your provider administers the second epistaxis.

However, in a situation such as yours, where your patient's diagnosis or situation has not changed between shots, use of the modifier would depend on whether your payer recognizes reporting units as a way to document the repeat injections in this scenario. If they do, you should bill two units of 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), assuming that this was the way your provider administered the drug.

If the payer doesn't recognize units, documenting the injections with two units may only get you paid for one. So, listing the injection on a second line with modifier 76 attached says that the same service was done on the same day for the same patient by the same physician and that it is not a duplicate.