Radiology Coding Alert

Question: If a patient has multiple chest X-rays on the same date, interpreted by the same physician, should I use modifier 76 or indicate the total in the unit field?

Virginia Subscriber

Answer: Either option may be appropriate for Virginia's J11 MAC Palmetto GBA. The goal is for the payer to be able to distinguish duplicate claims from instances where the patient had multiple identical services.

"The most effective method to ensure timely processing is to use the Days/Units Field and submit all services on one claim," Palmetto states.

Palmetto also offers several examples. For instance, consider this chest X-ray example, which uses both multiple units and modifier 76 (Repeat procedure or service by same physician or other qualified health care professional).

Example: A patient receives three separate chest X-rays at separate sessions on the same date. Palmetto offers two separate coding options.

Option 1: On a single claim, report:

• 71020 x1
• 71020-76 x2.

Option 2: On a single claim, report:

• 71020 x3.

Resource: To find the document, start at www.palmettogba.com/palmetto/palmetto.nsf/DocsCat/Home. Select J11 Part B MAC on the left side of the screen. On the new page, choose Browse by Specialty on the left side of the screen, and when the menu appears, choose Radiology. Finally, click the link for the 05/21/2012 article, Repeat or Duplicate Services on the Same Day.