Wiki Modifier 76 - supervisor at Tricare

[574coding]

Hello,
The coders here in our office have been informed by a collector that spoke to a supervisor at Tricare. They were told that we should be using modifier 76 when we are billing for additional levels. Example:

64483 L3
64484 L4
64484-76 L5

I always thought modifier 76 would be if the procedure is repeated due to unsuccessful or something along that line....

Does anyone have any info on this to support using modifier 76 or not using it? I have done research, all I have found is not to support using it, but our lead feels different .

Thanks

 

[twizzle]

Hello,
The coders here in our office have been informed by a collector that spoke to a supervisor at Tricare. They were told that we should be using modifier 76 when we are billing for additional levels. Example:

64483 L3
64484 L4
64484-76 L5

I always thought modifier 76 would be if the procedure is repeated due to unsuccessful or something along that line....

Does anyone have any info on this to support using modifier 76 or not using it? I have done research, all I have found is not to support using it, but our lead feels different .

Thanks

If you are doing it at a different level then it is not a repeat procedure. Example of a repeat procedure is a chest x-ray in the morning and another one in the afternoon (76 if second x-ray is by same provider, 77 if a different provider).
In your example, if the second 64484 was also at L4 level, then 76 may be justified.

 

[LeslieJ]

Modifier 76

To add to the excellent post by twizzle, we all thought (think) as you did, that if the same procedure is performed at the same location, we'd use modifier 76.

CMS/Medicare changed this definition not too long ago & that's why you're confused.

Go to your Medicare website & look up the new modifier rules on modifier 76.

Not sure where you're from, but here's a couple of links from WPS that help muddy the waters a little bit:

Modifier 76 fact sheet.
http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-76.shtml

Modifier 76 vs Modifier 59 fact sheet
http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifiers59and76.shtml



L J

 

[574coding]

Modifier 76

On the Noridian site for this modifier in CA, this is what it has (see below)...so if I understand this modifier, we would not use it for a "different level" because that was not a "repeated procedure"....

I want to make sure we bill it the correct way and that we understand the correct use of this modifier. In the past, we would use modifier 59 due to Note: If the procedures are performed on different sides of the body, modifiers RT and LT or another pair of anatomic modifiers should be used, not modifier 59 different site (level) or organ system, or separate lesion, incision, excision, injury or area of injury



Modifier 76


Repeat procedure or service by same physician or other qualified health care professional

Instructions

Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service.

Correct Use
? Procedure or service is usually performed on the same day
? Append 76 modifier to the repeated procedure or service CPT code only
? When two physicians are within the same group or same specialty = same physician
? Used for surgeries, x-rays and injections

Incorrect Use
? Not appropriate with laboratory or pathology codes(append modifier 91)
? Not appropriate to use with equipment failure
? Should not be appended to an E/M service
? Does not replace modifiers such as RT, LT, 50, E1-E4, FA, F1-F9, TA, and T1-T9

 

[574coding]

use of modifier 76 with Tricare

Hello,
I am back again with this modifier. I have not been using it, and it looks like it was added to the claim and billed out. it was paid, so now they want me to code it. I still feel it is not correct....

What does everyone else do???

We billed out coded 64483-50 L3, 64484-50 L4, 64484-59-50 L4 and they denied the 64484-59-50 but it looks like someone removed the 59 and put the 76 in the place and it paid.

They now want me to code with modifier 76 and not the 59 with Tricare.

Any additional help would be great!
Thanks