by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 18th, 2023
The Current Procedural Terminology (CPT®) for Level I CPT modifiers, describes a modifier as,
“A modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.”
Modifiers are also used to facilitate a healthcare professional’s ability to respond to specific payer payment policy requirements, such as those that exist in individual payer-provider contracts. Payers will often outline coding requirements that specify how and when certain modifiers should be reported and how they should appear on the claim form to facilitate processing and payment. While the CPT code book does not necessarily provide much direction in the application and use of modifiers, you can often find specific payer policies (e.g., Blue Cross/Blue Shield, Medicare) online and they often go into great detail to explain how procedures and modifiers should be reported and the documentation required to support them.
Modifiers 76 and 77 are reportable only with procedure services, not Evaluation and Management (E/M) service codes and are reported when the same procedure is performed more than once on the same patient, on the same date, either by the same or a different provider, as follows:
Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional (QHP). Modifier 76 is added to the CPT procedure code to describe circumstances in which the same provider performed the same procedure on the same patient more than once during the same encounter.
Example: A physician ordered an EKG (93000) which was performed in the office and then later, during the same encounter, performed a repeat EKG (93000). The initial procedure would be reported as 93000 (1 unit) and the repeat procedure as 93000-76 (1 unit). If that same provider happened to perform yet another EKG during the same encounter, then the second line of the claim would include 2 units rather than adding a third, separate claim line.
Modifier 77: Repeat procedure by another physician or other qualified health care professional (QHP). Modifier 77 is added to the CPT procedure code that describes a repeat procedure (same procedure) performed on the same patient, during the same encounter, but performed by a different provider.
Example: The hospital contracts with a group of radiologists. The documentation for Patient A includes the four chest x-rays during the same encounter date, as follows:
Claim entries would be as follows:
To reduce confusion that can lead to claim denials related to repeat service coding, do not add additional claim lines for each additional repeat procedure, but instead, increase the units of service for the repeat service to identify the second repeat service, third repeat service, and so on. This applies to both modifier 76 and modifier 77.
Coding Tip: Do not report modifiers 76 and 77 on the same procedure line, as these modifiers have different meanings.
Common Reporting Errors
- Appending to laboratory or pathology service codes (see modifier 91)
- Appending to an Evaluation and Management (E/M) service code
- Using modifier 76 instead of other required modifiers, such as RT/LT, 50, or other HCPCS modifiers
- Correct:
- Incorrect:
- Appending to add-on codes when multiples of the add-on procedure are performed (increase units for add-on procedure code instead)
- Adding to services that had to be repeated due to equipment or technical failures
Frequently Asked Questions:
Q: Can you report Modifier 76 and modifier 77 together?
A: Do not report modifiers 76 and 77 on the same claim line, as each modifier has a separate and distinct description and meaning.
Q: Can only physicians report Modifiers 76 and 77?
A: Physicians and other qualified health care professionals (QHPs) may report modifiers 76 and 77.
Q: What happens if you forget to append 76 or 77?
A: When multiples of the same procedure are reported on the same claim form or subsequent claim forms but same dates of service, the insurance payer will deny the second and each additional repeat procedure, as if it was a duplicate service rather than a separate service.
Q: Can you report modifiers 76 and 77 to an Evaluation and Management service?
A: No, modifiers 76 and 77 are not reportable with any E/M service. Do not append the modifiers to the E/M code. They may be reported on the same date as an E/M service but must be appended to the procedure code, not the E/M service code.
Q: What is the difference between modifier 76 and modifier 59?
A: Modifier 76 is used to report a circumstance where the same provider performs a repeat procedure (exact same procedure code) on the same patient during the same encounter. Modifier 59 is reported when two different procedures are performed during the same operative session and one of the two is considered bundled into the primary procedure by way of a National Correct Coding Initiative edit (NCCI edit) and otherwise would be denied. The documentation must explain or support overriding the CCI edit to allow payment for the otherwise bundled secondary procedure.
References/Resources
About Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Aimee L. Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. Aimee believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.
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