Radiology Coding Alert

Question: Should I use modifier 76, 77, or 59 when a patient is seen twice on the same date of service for pre-reduction (73610) and post-reduction (73600) studies? I've heard conflicting views on whether I may use 76 and 77 when the CPT codes are different.

Massachusetts Subscriber Answer: Unless your payer tells you differently, use modifiers 76 (Repeat procedure by same physician) and 77 (Repeat procedure by another physician) only when the physician(s) perform the exact same exam twice.

For example, if a patient in the intensive care unit has two single-view chest x-rays (71010, Radiologic examination, chest; single view, frontal) on the same day, report the second exam with modifier 76 or 77 (depending on whether both exams involved the same physician). 

On the other hand, if the patient had, as you describe, a complete exam (73610, Radiologic examination, ankle; complete, minimum of three views) followed later in the day by a limited exam (73600, ... two views), use modifier 59 (Distinct procedural service) to tell the payer the provider(s) performed the exams in separate encounters.