Primary Care Coding Alert

Question: My physician saw a patient in the office for a nosebleed. Later that day, the patient returned and was treated by another physician for severe nosebleed. She spent an hour to get the nosebleed under control. Should I use modifier 77 to bill both doctors' services?

Tennessee Subscriber

Answer: No, modifier 77 (Repeat procedure or services by another physician or other qualified health care professional) is unnecessary.

In the example you provide, you'll submit either 30901 (Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method) or 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) for the procedure performed by the first physician, depending on the extent of that service. Assuming the second physician is in the same practice as the physician who controlled the nosebleed initially, you'll append modifier 59 (Distinct procedural service) to the second physician's claim, which should be for 30903. Modifier 59 makes it clear to the payer that the services were distinct and provided to the patient at two different encounters. It also makes it clear that you are not inadvertently billing twice for the same service. If the second physician is not in the same practice and works for a different practice and under a different tax ID, you do not need a modifier.

Tip: As noted, even if your physician performs two different but potentially related procedures at different times on the same date, for example 30905 (Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial) and then 30906 (...subsequent), you should use modifier 59 to indicate that the two procedures were performed at different encounters.