Wiki repeat procedure on a different date

[prem_ponnuru]

Hello,

Can anybody suggest me what modifier is to be used if provider is repeating the same procedure like 37765 on a different date of service say after 20 days in a different hospital 76 or 78 ???

thansk for all the input.

Prem.

 

[scicchitanoa]

Modifier 78 may be your best option. Modifier 76 is used to report a repeat px by the SAME physician on the SAME calander day as the originial px. Ex - physician cauterizes a patients nostril for bleeding, then later that day the same physcian cauterizes and packs the same nostril for rebleeding.

 

[prem_ponnuru]

thx for response

Hi

Thanks for your response.

But in the description of the mod 76 in the cpt book, I did not found that it must be used on the same day. I feel it is used mostly on the same day but can be used even in the global period also.

Any comments please....

Prem.

 

[ramcpc]

Need Little bit more info.

Dear Prem,

Can you tell me that both the services are rendered in the same extremity or different extremity? Since the CPT code 37765 says One Extremity with 10-20stab incisions and 37765 having 90 days global period.

Per CPT, To use mod 76 the DOS should be same. So you cannot use Mod 76.

Depends on the services rendered, You can use Mod 78. If suppose, 37765 done in the RT and LT then the Mod 78 is not applicable.

Thanks,
B.T.RamKumar, MBA, CPC.

 

[prem_ponnuru]

Thx for response

Hi Ram kumar,

How ru ?

Thanks for your input.

The procedure was done on same side LT and icd is also same. If i use 78 mod insurance ppl are asking for meidcal necessity.

I will agree in this scenario I should use 78 mod as it is a major surgery and 76mod is generally used for minor surgereies and procedures like x-rays and all.

But still I have a feeling that I can use 76 mod in global periods also for minor surgeries with 10 day gloabla period.

Please let me know ur valuable comments.

Prem.

 

[ramcpc]

You Can't use mod 76

Dear Prem,

I am doing good. Thanks & what about you?

The below given description clearly illustrates that you can't use the Mod 76.

REF: APPENDIX A - MODIFIERS, CPT - 2008.

78 - Unplanned Return to the Operating/Procedure Room by the same physician following Initial procedure for a related procedure during the postoperative period.: It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (Unplanned px following initial px). When this px is related to the first and requires the use of an operating or room, it may be reported by adding mod 78 to the related procedure.(For repeat procedures on the same day, See76).

Obviously insurance will ask the medical necessity for the same procedure since the patient is in Global period. There should be some reason for the repeatation. So you check with the medical record and find out the valid reason for the procedure repeatation. Hope there would be some other reason/complication for the repeatation.

Thanks,
B.T.RamKumar, MBA, CPC.

 

[FTessaBartels]

You CAN use modifier 76

Per the AMA guidelines reported in Coding With Modifiers: A Guide to Correct CPT and HCPCS Level II Modifier Usage, Second edition, by Deborah J Grider, copyright 2006 by American Medical Association:

"Modifier 76 should be used to for all procedures when the physician repeats the procedure the same day or during the postoperative period. (emphasis added by FTBartels)

"This modifier indicates that the claim is not a duplicate bill, but is the same procedure that was performed earlier.

"The procedure repeated must be the same procedure (same procedure code) by the same physician.

"An explanation of medical necessity for the repeat procedure is required by many insurance carriers."

This book does NOT state that Mod 76 is only for minor (10-day global or less) procedures. In fact one of the example scenarios they list is for CPT 32110 repeated on a subsequent day, but still within the 90-day global period.

But be prepared to present evidence of medical necessity.

F Tessa Bartels, CPC, CPC-E/M

 

[aguelfi]

Iwas always taught (and followed) that using a 76 is something preformed in the office or diagnostic testing or such, but when it warrants a trip back to the OR to use a 78. It specifically states Unplanned return and you take a 20% reduction in you're reimbursement but you're post-op period doesn't start back over. The 90 days continues from the original surgery date (that's what the 20% hit is for).

 

[prem_ponnuru]

Thank you so much..!!

Hi Bartels and Adrianne,

Thank you so much for the information on AMA guidelines. This is very helpful.

Prem.

 

[FTessaBartels]

2008 CPT has changes to modifier 78

Adrienne,
Yes, I had been taught differently as well ... but Prem's question got me thinking and researching ...

In fact, I just noticed today that the 2008 CPT appendix A (I use professional edition, page 458-59) description for Modifier 78 has as the last statement
" (For repeat procedures, see modifier 76.) "

I love this forum ... I learn something every day!

F Tessa Bartels, CPC, CPC-E/M

 

[aguelfi]

I have never heard that, I'll have to check it out. Thanks

 

[prem_ponnuru]

confused

I am confused ,

Please clarify,so can i use the 76 mod on a different date for the same procedure same side,same physician or not?

Prem, B.Pharm,CPC.

 

[sasikumars]

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.
This modifier indicates the claim is not a duplicate bill but is for the same procedure or service that was performed earlier.
The procedure repeated must be the same procedure or service (same procedure or service code) by the same physician or other qualifi ed health care professional.
An explanation of medical necessity for the repeat procedure or service is required by many insurance carriers


Example A 38-year-old male was admitted to the emergency department with hypotension and a stab wound of the high right anterolateral portion of the chest after an attempted robbery. Diagnostic tests were ordered and reviewed to rule out other injury and to plan the operative approach. The surgeon reviewed and assessed preexisting medical problems, laboratory studies, and all X rays and other imaging studies; evaluated the pulmonary and cardiac function; stabilized the patient’s condition; and prepared and transported the patient for emergency surgery. The physician communicated with the patient and family and coordinated care with other physicians and health care providers. At operation, through a posterolateral thoracotomy, the hemithorax was explored, the blood clot was evacuated, and a bleeding source in the lacerated lung was identifi ed and repaired. The entire thorax and all thoracic and mediastinal structures were explored to rule out other injury. Chest tubes were placed as appropriate. The next morning, the patient was returned to the operating room to repeat the procedure because of another blood clot in the hemithorax. The blood clot was evacuated, and another bleeding source in the lacerated lung was identifi ed and repaired. CPT Code(s) Billed for First Procedure: 32110 Thoracotomy; with control of traumatic hemorrhage and/or repair of lung tear CPT Code(s) Billed for Second Procedure: 32110 76.

Hope it helps.