Modifier 76 and 77

Channagangaiah August 30, 2019February 28, 2020

Modifier 76:

Modifier 76 is appended, when the repeat procedure or service performed following to the original procedure by the same physician/other qualified healthcare professional on the same day.

It means we need to indicate modifier 76, when services are repeated on the same day by the same physician/other qualified healthcare professional.

Important Note: Modifier 76 should not be reported with an Evaluation and Management services.

Modifier 77:

Modifier 77 is appended, when repeat procedure or service performed by another physician/other qualified healthcare professional on the same day.

It means we need to indicate modifier 77, when services are repeated on the same day by another physician/other qualified healthcare professional.

Important Note: Modifier 77 should not be reported with an Evaluation and Management services.

The usage of modifier 76 and modifier 77 under radiology:

Example 1:

Let us consider the below Scenarios:

Scenario 1:

Assume same physician performed the radiological examination twice (under two different sessions) on the same day, on the same region (Right elbow, 3 views) to patient Harry.

We report the above health care service with the following procedure codes:

Right elbow 3 views 73080 with modifier RT (Radiological examination, elbow; 3 views)

But here it is a repeat procedure code, and if we bill the same CPT code on the same day the insurance company will deny the claim as duplicate.

So if the services performed repeatedly after the instructions from the physician, then we need use an appropriate modifier to reimburse the payment from insurance company.

If the same physician does both the service on the same day we append the procedure codes with the modifier 76

CPT code 73080 appended with modifier 76 and RT

CPT code 73080 appended with modifier RT.

Scenario 2:

Assume another physician (Doctor B) performs the radiological examination of right elbow,3 views on the same day, subsequent to the original procedure(radiological examination of right elbow, 3 views) which was performed by Doctor A.

If the same service repeated by two doctors A and B on the same day, then we report the service with appending modifier 77 as follows:

Doctor A: Report the CPT code 73080 with modifier RT

Doctor B: Report the CPT code 73080 with modifier 77 and RT

Example 2:

Three views of the right foot X-ray was done at 12:00 hours by Dr. Chris and the same procedure was repeated at 16:00 hours by Dr. Alex on the same day

In this case, Dr. Chris has to report his claims as follows:

Procedure code 73630 with modifier 26 and modifier RT

Dr. Alex has to report his claims with modifier 77 as follows:

CPT code 73630 with modifier 26, modifier RT and modifier 77

Example 3:

Three views of the left foot X-ray was done at 12:00 hours by Dr. George and the same procedure was repeated at 16:00 hours by same physician (Dr. George) on the same day.

In this case the same physician repeats the procedure, subsequent to the original procedure. Hence it’s reported with modifier 76 as follows:

CPT code 73630 appended with modifier 26 and modifier LT

CPT code 73630 reported with modifier 26, modifier LT and modifier 76.