Sunday, September 5, 2010

Repeat Procedure by the Same Physician - Medicare modifier 76

Modifier 76 Fact Sheet

Definition:

• Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day.

Appropriate Usage:

• On procedure codes that cannot be quantity billed

• Report each service on a separate line, using a quantity of one and append 76 to the subsequent procedures

• The same physician performs the services

Inappropriate Usage:

• Appending to a surgical procedure code
• Appending to each line of service
• Repeat services due to equipment or other technical failure
• For services repeated for quality control purposes

Additional Information:

• Medicare considers two physicians, in the same group with the same specialty performing services on the same day as the same physician

• For all procedure codes that cannot be quantity billed, always use a quantity of “1”
• To avoid denials, bill all services performed on one day on the same claim
• For repeat clinical diagnostic laboratory tests, use modifier 91 if the service can not be quantity billed
• Indicate in the electronic narrative record or Box 19 of the CMS 1500
claim form, the total number of services performed that day

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