Tuesday, February 15, 2011

Repeat procedure by same physician

Modifier 76 (Repeat Procedure)

The physician may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding the modifier 76 to the repeated
procedure/service. From a coding perspective, modifier 76 is intended to describe the same procedure or service repeated, rather than the same procedure being performed at multiple sites.

Prior to January 1, 2004, providers were advised to file multiple services with modifiers Y2-Y9 and Z2-Z3 to avoid services being denied as duplicates. Since these modifiers have been eliminated, we are revising
instructions for filing multiple services that are performed on the same day. The appropriate use of CPT and HCPCS codes is required when filing claims. In addition, diagnosis codes and modifiers should assist
with accurately describing services billed. It is necessary to append the appropriate anatomical modifiers to procedure codes to differentiate between multiple sites. If a claim drops for manual review, the
appropriate use of diagnosis codes and modifiers may assist claim reviewers in determining the intent of billing without having to request documentation. As always, providers can continue to file modifiers RT
and LT when two of the same procedure is performed and one is on the right side and one is on the left side of the body. However, if more than one service is performed on the right or left side, services could be
denied as duplicates if more than one RT or LT modifier is filed on the same procedure code. Modifier 76 is defined by the CPT as “Repeat Procedure by Same Physician”.

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