Radiology Coding Alert

Question: We have a patient that received a total of four single-view chest X-rays on the same date of service. The first two were performed in the morning by one radiologist, and the second two were performed in the afternoon by a different radiologist. How should modifiers be appended?

Illinois Subscriber

Answer: Going over the modifier placement logistics might make your head hurt for a moment, but the coding is relatively straightforward so long as you’re comfortable with the look of a code that’s got both modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) and 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional) appended to it.

For the morning encounters, your coding should look as follows:

• 71045 (Radiologic examination, chest; single view)
• 71045-76

When coding the afternoon set of chest X-rays, you’ve got to take into account the morning services when considering modifier placement. Because there’s a new provider reading the afternoon X-rays, you know modifier 77 is appropriate on both sets of afternoon services. However, you’ll also be appending modifier 76 on one of the two afternoon codes since the second afternoon chest X-ray is a repeat procedure by the same physician. The coding for the afternoon services will look as follows:

• 71045-77
• 71045-76,77.