Primary Care Coding Alert

Question: A patient has pressure sores that were 20 sq cm on his right ankle and right hip that the FP debrided in the morning. Because of the patient's condition, selective debridement of a 17 sq cm sacral pressure sore was performed at a separate session in the afternoon on that same date by the same physician. Should I use modifier 76 for a repeat procedure?

Nevada Subscriber

Answer: No, you should use modifier 59 (Distinct procedural service), rather than modifier 76 (Repeat procedure or service by same physician).

Report modifier 76 when the same physician has to duplicate the same procedure for instance, because the first was unsuccessful, such as a repeat inhalation treatment (94640-76, Pressurized or nonpressurized inhalation treatment for acute airway obstruction -).

Use modifier 59 when documentation shows that medically necessary circumstances, such as separate sessions, make reporting two codes that would not normally be reported together acceptable. For instance, in your case, the FP would report the same debridement code (such as 11040, Debridement; skin, partial thickness) with modifier 59 appended in the second instance. Without modifier 59, the insurer's software edit system may kick out the second 11040 as duplicate to the first.