Radiology Coding Alert

Can you report a repeat test when equipment fails? Find out.

Many myths surround the use of repeat procedure modifiers when reporting repeat imaging tests. Coders can face challenges when radiologists need to repeat X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) scans.

Dive in to debunk these modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) and modifier 77 (Repeat procedure by another physician or other qualified health care professional) myths.

Myth 1: You Can Append Modifiers 76/77 to E/M Services

While you can append some modifiers, such as modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service), to evaluation and management (E/M) services, you cannot use modifiers 76 and 77 with E/M codes. “These modifiers are never applied to E/M services. They can apply to both diagnostic and surgical procedures that are repeated,” says Melanie Witt, MA, RN, an ob-gyn coding expert based in Guadalupita, New Mexico.

In fact, Appendix A of the American Medical Association (AMA) CPT^® code set features instructional notes tied to modifiers 76 and 77 that state “This modifier should not be appended to an E/M service.”

Tip: Each individual payer may have their own rules, so it’s important to review your individual payer policies. For example, the “Modifier 76 Fact Sheet” from Medicare Administrative Contractor (MAC) WPS lists inappropriate uses of modifier 76, including “appending to a surgical code.”

Myth 2: You Can’t Use Modifier 77 for a Second Interpretation of an ED X-Ray

Payers may cover a second interpretation of an X-ray for an emergency department (ED) patient only under unusual circumstances. But you may encounter times where it’s appropriate to report a second interpretation with modifier 77 appended.

Reporting a second X-ray interpretation for an ED patient may be appropriate when there is “a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure,” states Medicare Claims Processing Manual, Chapter 13, Section 100.1. In other words, look for medical necessity before reporting that second interpretation and don’t try to claim reimbursement for a second interpretation performed as part of hospital quality control.

The manual provides the example of a treating physician seeing an ED patient and ordering a single-view chest X-ray. The treating physician documents a complete interpretation of the X-ray and reports that interpretation by appending modifier 26 (Professional component) to the X-ray code. A radiologist also performs an interpretation of the X-ray, agreeing with the treating physician’s assessment that the patient does not have pneumonia but adding that a suspicious area of the lung suggests a tumor that requires further testing. The radiologist appends modifier 77 when reporting this interpretation to let the payer know the radiologist is reporting a repeat procedure by another physician. The manual states the MAC should pay for both the treating physician’s interpretation and the radiologist’s interpretation in this situation.

Myth 3: You Can Use Modifier 76 For Repeated Procedure Due to Equipment Failure

Scenario: A patient presents to your radiology facility for a magnetic resonance imaging (MRI) scan of their left knee. The patient twisted the knee while playing a football game and the patient’s primary care physician (PCP) wants to check for damage to the tendons and ligaments. The tech performs an MRI with contrast of the knee, but the MRI machine breaks down during the procedure. The tech and patient move to another imaging suite, where the tech performs the test fully. After the test, the radiologist interprets the results and submits their findings to the patient’s PCP.

In this scenario, you’ll assign 73722 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)) to report the MRI of the patient’s knee. You may append the CPT^® code with modifier LT (Left side) to indicate laterality, if your payer prefers that information. However, you cannot report 73722 for the first attempt that failed and 73722-76 for the second attempt that succeeded.

MACs, such as Novitas Solutions, deem “Repeat services due to equipment/technical failure” inappropriate uses of modifier 76 (www.novitas-solutions.com/webcenter/portal/ MedicareJL/pagebyid?contentId=00092327). Since the practice moved the patient to another machine due to the first machine’s equipment failure, the practice should report only the successful MRI service.