Wiki repeat Destruction plantar wart (17110) in global, modifier 76 appropriate??

[heatherposchman1]

When multiple destructions are required and may be in the global period, is modifier 76 appropriate to append? CGS J15B lists this modifier as used when the procedure is repeated multiple times "in the same day", but CPT guidance does not stipulate the repeat procedure to be in the same day.

 

[thomas7331]

Modifier 76 is not for use during the global period; as CGS states, it's only for procedures repeated on the same day (and is primarily used for non-surgical procedures - most payers prefer the 59, XS, XE, XP, XU modifiers for repeated surgical procedures on the same day).

For procedures done during the global period, you'll need to consider modifiers 58, 78 and 79, if supported by documentation. CMS publishes this helpful booklet with goes into detail about what can reported and how it should be coded: Global Surgery Booklet

 

[podcoder70]

17110 is for destruction of up to 14 lesions (warts) and has a 10 day global. It would be difficult to medically justify the repeat procedure during the global period. If it can be medically justified, only modifiers 58 or 79 would be appropriate in my opinion.

 

[heatherposchman1]

Modifier 76 is not for use during the global period; as CGS states, it's only for procedures repeated on the same day (and is primarily used for non-surgical procedures - most payers prefer the 59, XS, XE, XP, XU modifiers for repeated surgical procedures on the same day).

For procedures done during the global period, you'll need to consider modifiers 58, 78 and 79, if supported by documentation. CMS publishes this helpful booklet with goes into detail about what can reported and how it should be coded: Global Surgery Booklet

Thank you, Below is a copy/paste from CPT assistant article August 2011; Volume 21: Issue 8

Use of Modifier 76

1. Modifier 76 should be used for all procedures when the physician or other qualified health care professional repeats the procedure or service the same day or during the postoperative period.
2. Modifier 76 indicates that the claim is not a duplicate bill but is for a second incidence of the same procedure or service.
3. The repeated procedure reported with modifier 76 must be the same procedure or service (ie, same procedure or service code) by the same qualified health care professional.
4. An explanation of medical necessity for the repeated procedure or service reported with modifier 76 is required by many insurance carriers.

So, if CPT guidance does not stipulate the repeat procedure to have been only in the same day, and if the payor is not CGS (who does stipulate the repeat procedures to be in the same day) then why would 76 not be appropriate for repeat of wart destruction within the 10 day global? In many of our derm providers notes, they advise the patient that the procedure may have to be repeated several time for complete resolution of the wart. I am asking "why" not to be contrary but to get a better understanding.

 

[thomas7331]

I can’t tell you why CPT Assistant would give that guidance, though I do see that it is almost 12 years old so may be out of date now. I don’t think that the modifier is necessarily inappropriate to use on a subsequent date, but only modifiers 58, 78, and 79 will work to get a procedure paid during the global period, so coding modifier 76 would not really serve any purpose. You’re welcome to try it and see what happens, but in my experience over 20 years of billing is that this modifier isn’t for surgical procedures, it’s for things like EKGs and X-rays to report when the test must be repeated again on the same date for a particular reason. Surgical procedures aren’t normally ‘repeated’ on the same day. You often report a code more than once, but that’s because the same procedure is performed at a separate site (i.e. modifier 59 or XS) not because the original procedure had to be performed again.

 

[heatherposchman1]

I can’t tell you why CPT Assistant would give that guidance, though I do see that it is almost 12 years old so may be out of date now. I don’t think that the modifier is necessarily inappropriate to use on a subsequent date, but only modifiers 58, 78, and 79 will work to get a procedure paid during the global period, so coding modifier 76 would not really serve any purpose. You’re welcome to try it and see what happens, but in my experience over 20 years of billing is that this modifier isn’t for surgical procedures, it’s for things like EKGs and X-rays to report when the test must be repeated again on the same date for a particular reason. Surgical procedures aren’t normally ‘repeated’ on the same day. You often report a code more than once, but that’s because the same procedure is performed at a separate site (i.e. modifier 59 or XS) not because the original procedure had to be performed again.

Thank you, I appreciate the info and your time.