Radiology Coding Alert

Learn CMS' rule for procedures performed 3 times in 1 day Payers may think you made a typo if you leave 76 and 77 off claims for repeat services. Show payers you've got coding down cold by applying these modifiers correctly every time.

When you'll use them: Physicians often take multiple x-rays that reflect different views of the same anatomic area to get a better idea of the patient's condition.

For example, if a patient has chest pain or a possible fracture, the doctor may order several views of those sites. In cases like this, forgetting to append modifiers 76 (Repeat procedure by same physician) or 77 (Repeat procedure by another physician) to the x-ray code can lose you reimbursement.

Modifiers 76 and 77 tell your payer that you know the CPT code is the same as the one above it (or reported earlier), but it is a repeat, not a duplicate, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J.

Back Up 76 Use With Medical Necessity Hint: Make sure you have an explanation of the medical necessity for repeating the procedure, says Cobuzzi, who presented on modifiers at the Fifth Annual Ingenix Essentials Conference.

Example: A physician performs two chest x-rays on a patient who has come to the emergency department with chest pain. The same radiologist interprets both films. In this case, failing to append modifier 76 to 71020 (Radiologic examination, chest, two views, frontal and lateral) could cost you almost $90.

Payers also typically pay for pre- and post-reduction x-rays if you append 76, Cobuzzi says.

Example: A patient presents with a broken wrist  requiring pre-and post-reduction x-rays. You should report 73100 (Radiologic examination, wrist; two views) and 73100-76.

Guideline: CMS says that when repeating a service is medically necessary, you should report the first service as usual and report the repeat service on the next line, appending 76. If you repeat a service more than twice, you should indicate this by increasing the number of units in the unit field of the repeat service, says Suzan Hvizdash, BS, CPC, CPC-EMS, CPC-EDS, physician educator at the University of Pittsburgh Medical Center, citing the Medicare Part B Reference Manual, Appendix B -- Modifiers, at www.highmarkmedicareservices.com/partb/refman/appendix-b.html#3.

Example: Based on your documentation, you know the radiologist performed three medically necessary services meriting 73100. You report one unit of 73100 and two units of 73100-76.

For repeat services, provide additional documentation in the narrative field and include documentation of medical necessity for the repeat service in the patient record, Hvizdash says, again citing the manual. Check Local Rules on 77 You'll typically use modifier 77 when a second physician from the same specialty and same tax ID number performs the same [...]