Radiology Coding Alert

Modifier Mania:

4 Tips to Help You Differentiate Modifiers 76 and 77

Published on Mon Jun 24, 2024

Pay attention to which provider repeats the service.

It’s a common occurrence: Your radiologist performs the same service for the same patient more than once on a single date. If you report the corresponding CPT® codes on separate lines of your claim form without a modifier appended, you’re likely to get a denial for submitting a duplicate service. Your best bet? Adding the appropriate modifier to your code.

If your head spins when trying to pinpoint the right modifier to use for repeat services, check out four quick facts that can help you iron out the details.

1. Get the Definitions of Your Main Options

Before you can differentiate one modifier from another, get to know the two main options to consider:

76 (Repeat procedure or service by same physician or other qualified health care professional)
77 (Repeat procedure or service by another physician or other qualified health care professional)

Once you have these descriptors in front of you, it’s time to move on to the best ways to tell them apart.

2. Identify the Provider Who Performed the Service

The difference between modifier 76 and 77 is that you use modifier 76 when only one radiologist performs the procedures or services, and you use 77 when there is a second provider performing the subsequent procedure or service.

When you find that your radiologist repeats a procedure on the same date, look to see if there was a second radiologist before you make your modifier decision. When there are two providers, they need to be in the same practice or group for the service to qualify as a repeat. If the two physicians are in different groups, you can simply report the code for the second radiologist’s service with no modifier.

3. Single Provider? Look to 76

Modifier 76 is your go-to choice when the same provider performs both procedures.

How you’ll list the codes on your claim form may depend on your payer.

For instance, according to a January 2024 Fact Sheet from Part B Medicare Administrative Contractor (MAC) Novitas Solutions, you should append modifier 76 to the code, along with the number of repeated services, on one claim line. “Do not report modifier 76 on multiple claim lines to avoid duplicate claim line denials,” Novitas says. “Bill all services performed on one day on the same claim, to avoid duplicate claim denials.

However, Part B MAC >NGS Medicare states, “The procedure code is listed once, and then listed again with modifier 76 added (two line items.) The second line item will have the appropriate quantity billed amount.”

Example: A patient comes into your office in the morning for a two-view chest X-ray. After the procedure, the radiologist identifies an abnormality on the images, and requests the patient return for additional X-rays. That afternoon the patient returns for another two-view chest X-ray exam.

You would report 71046 (Radiologic examination, chest; 2 views) for the morning X-rays and 71046-76 for the afternoon X-rays.

4. Different Provider Warrants 77

You’ll use modifier 77 when one provider in your practice performs the first service and a separate provider performs the second. If you submit identical, duplicate services for the same date of service “by another performing provider with the same specialty within the billing group without the use of any modifier,” you’ll find your claim denied, according to February 2024 guidance from Blue Cross Blue Shield of North Dakota.

Example: Suppose the patient from our example above presents to your office in the morning for the X-rays and Dr. Smith performs the procedure. Later in the afternoon that same day, the patient returns and sees Dr. Jones (another radiologist) for another two-view chest X-ray.

You would report 71046 for Dr. Smith’s time with the patient, and 71046-77 for Dr. Jones’ work with the patient. Novitas notes that you should report each procedure on separate claim lines — once alone (71046 with no modifiers) and once with modifier 77 appended. “Do not use the units field to indicate the procedure was performed more than once on the same day,” Novitas adds.

Beware: Payers may have their own individual policies on how to use modifiers 76 and 77 so be sure to contact your payer for clarification before you start using them.

Torrey Kim, Contributing Writer, Raleigh, N.C.