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Answer: This is a common occurrence, and most payers recognize it as such. The documentation needs to indicate why two x-rays were done on the same day and were read by two different radiologists (which is the function of modifier -77 [repeat procedure by another physician]). You do not need to provide an explanation of the circumstances that caused the second radiologist to become involved.
This situation might occur if a newborn is suffering from respiratory stress syndrome (769), for instance. It may be medically necessary to perform four or five chest x-rays on the same day to assess how well the infants lungs are functioning. The first x-ray would be reported using 71010 (radiologic examination, chest; single view, frontal). Subsequent x-rays, read by a different radiologist, would be assigned 71010-77. Of course, if the same radiologist read any of these x-rays, they would be coded 71010-76. Modifier -76 describes repeat procedure by same physician.
Another example may occur in the emergency department if a trauma patient presents with a broken arm (ICD-9 812.40 , fracture of humerus, lower end, closed unspecified part). An x-ray may be taken to locate the fracture (73060, radiologic examination; humerus, minimum of two views) and then repeated after the cast had been applied to determine that the bone had been set correctly.
In this instance, the initial x-ray would be coded 73060, while the second would be assigned 73060-77 if a different radiologist read the films, or 73060-76 if the same radiologist performed this service.
Coders should recognize that payers in some areas do not allow the use of modifiers -76 and -77. Instead, alternative systems have been implemented. As always, follow the instructions of your local payers.
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