Thursday, June 10, 2010

Repeat procedure by the same physician - 76 Modifier

Part - A  Level I Modifiers 76

Description Repeat procedure by the same physician.

Required for Claims Hospital Outpatient Prospective Payment System (OPPS)

Type of Bill: 12X, 13X

Coding Guidelines Generally applied to surgical (CPT 10000-69990), radiological procedures (CPT 70010-79999) and other diagnostic services (CPT 90281-99569)

General Guidelines

A. Modifier –76 is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician.

B. This modifier may be reported for services ordered by physicians but performed by technicians.

C. The procedure/service code is listed once (without the modifier) and then the code is listed again with a modifier –76 added (two line items). The number of times the procedure/service was repeated is reported on
separate lines (with modifier –76).

D. For surgical procedures, report the CPT code without modifier –76 to indicate the first time the procedure was performed. For each additional time the procedure was performed, the CPT code is repeated with modifier –76 added. Do not use the units field to indicate that the procedure was repeated more than once on the same day.

E. If you are not sure who ordered the second procedure, or whether the same physician ordered the both procedures, code based on the physician who performed the procedure(s).

F. The repeated procedure MUST be the same procedure.

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