Wiki Modifier 77

[janellglascock@gmail.com]

We are having an issue with 93010 being denied as "billed by a different provider", but the provider isn't one of ours. We have only billed 93010 once. Can I just slap a modifier 77 on there and assume a different doctor with a different service billed for this interp also? Is modifier 77 appropriate if we have only billed for one? Thanks!

 

[thomas7331]

It depends on the circumstances. Modifier 77 is for a procedure that was repeated on the same day due to a medically indicated reason, e.g. a change in the patient's condition required doing the test again a second time to re-evaluate - if it's the case with your EKG that , then that modifier would be appropriate. This modifier isn't appropriate for having a second provider do another interpretation on the same test. CMS (and probably most other payers) policy is to pay only the first interpretation that is billed - additional interpretations of the same test are not reimbursed.

 

[janellglascock@gmail.com]

Thanks!