What is 76 Modifier?

Modifier 76:

Represents a repeat procedure by the same physician on the same day. Repeat procedure or service by the same physician or other qualified healthcare professional.

As per Medicare when two physicians in the same group with the same specialty performing repeat services on the same day are considered as the same physician. Then we have to append modifier 76 with the subsequent repeat procedure within the same day..Medical Coding Training

Instructions:

Used to indicate a procedure or service was repeated by the same physician or other qualified healthcare 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.

Proper use of 76 Modifier :

Use the 76 modifiers when billing for a separate office or outpatient E/M visits that occur on the same date of service (only for codes 99211–99215) by the same physician/practitioner.

Each service should be clearly documented.

Use the 76 modifiers to indicate a separate encounter occurred on the same date of service when separate services are billed. Do not use the 76 modifiers for the initial visit.Medical Coding Training

Example of Proper Usage :

A patient visits the physician on Wednesday morning for a bladder infection. She is treated and sent home. That same afternoon, the patient returns to the physician’s office with a twisted ankle. Each service should be reported with the appropriate level of E/M service with the 76 modifiers added to the second visit for the twisted ankle.

Eg: When a physician (A) order 2 views of chest x-ray at 10 am and due to medical necessity he orders for another 2 views of chest x-ray at 11 am and 12 pm on the same day, append modifier 76 with the subsequent repeat procedure codes.

DOS: 1/1/2016 all the 3 chest X- rays were ordered by the same physician.

1. am 71020
2. am 71020 – 76
3. pm 71020 – 76

Note:

It’s inappropriate to use modifier 76 with any Lab codes, for repeat laboratory test within the same day - Use modifier 91 instead of 76.

It’s inappropriate to use modifier 76 with subsequent repeat procedure due to technical fault or equipment issue.

It’s inappropriate to use modifier 76 with subsequent repeat procedure but at a different anatomic site (Right & Left or upper & lower part), use modifier 59.

Eg: 93970 – upper extremity and lower extremity duplex scan of vein performed on the same day at different sessions. It’s more appropriate to use modifier 59 instead of modifier 76.

For More Info: Medical Coding Training

This is poojitha working as a medical coder at Andromedatechs