Pulmonology Coding Alert

Avoid duplicate denials by identifying 94640, 32002 as repeats Medicare considers modifiers 76 and 77 "informational only" -- meaning that they will not affect your reimbursement -- but encourages practices to use these modifiers "when appropriate." Make sure you know what that means because it can affect your pay-up.

Don't make this mistake: You may think, "If 76 and 77 have no effect on reimbursement, why bother?"

Here's your reason: Not only do correct coding guidelines direct you always to report your claims to the highest level of precision, but knowing how to apply 76 and 77 properly will also help you to know when to use other, payable modifiers.
 
Day and Procedure Must Be Identical
 
You should append modifiers 76 (Repeat procedure by same physician) and 77 (Repeat procedure by another physician) when the same physician or a different physician, respectively, must repeat an identical procedure for the same patient on the same day. The procedure involves the same CPT code, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, coding analyst with CodeRyte Inc. in Bethesda, Md.

Problem: When a payer sees the same CPT code, the reviewer or system often considers the second code a duplicate or a billing error, Jandroep says. To tell the insurer that the charge is a repeat, you use modifier 76.

Example: A patient presents with an asthma exacerbation (such as 493.02, Extrinsic asthma; with [acute] exacerbation). A pulmonologist measures peak flow and orders his staff to administer an inhaled bronchodilator treatment (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device]). A post-treatment peak flow measurement shows that the patient's airway obstruction has improved but is still comprised. The pulmonologist orders another bronchodilator treatment. In this case, you should report 94640-76 for the repeat treatment by the same physician.  

Important: If the patient has to return later the same day for a repeat inhaled bronchodilator treatment, you should use the same CMS-1500 claim form for both sessions. If you separate the claims for the two identical, same-day services, Medicare will deny the second claim as a duplicate service, even if you append modifier 76. Switch to 77 for Different Physician When a different physician has to repeat a same-day procedure, you should use modifier 77 for the latter procedure. The modifier tells an insurer that a claim from a separate physician is for repeating the same procedure performed earlier in the day by another doctor and is therefore valid and not duplicative.

Modifier 77 is critical for correct reimbursement purposes. Medicare will reduce the fee on procedures appended with modifier 76, Jandroep says. But carriers will not subject modifier [...]