AHA Coding Clinic® for HCPCS - 2009 Quarter 2; FOR your INFORMATION
Inherently Bilateral Procedures
The Centers for Medicare & Medicaid Services (CMS) has received reports of clinical scenarios where a bilateral procedure may be performed more than once per day on the same date of service for the same patient. CMS has advised hospitals to report the procedure performed with modifier 76, Repeat Procedure or Service by Same Physician , appended to the additional procedure code(s). For example: A patient comes in to the hospital outpatient department and has the same procedure (CPT code 70330 , Radiological examination, temporomandibular joint, open and closed mouth; bilateral) performed twice in the same day. The first was a...
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Article Overview
This article addresses CMS guidance for hospital outpatient reporting when a bilateral procedure is performed more than once on the same date of service for the same patient. It is relevant to hospital coders, outpatient billing staff, and compliance teams looking for general guidance on repeat procedures, modifier use, and a CPT example that illustrates the scenario.
Why This Topic Matters
Understanding how CMS discusses repeat bilateral procedures helps hospitals apply consistent outpatient reporting practices and avoid claim submission issues. The article also provides a CPT-based example tied to a CMS modifier reference.
What You Will Learn
- How CMS addresses repeat performance of a bilateral procedure on the same date of service
- The general reporting context for hospital outpatient procedures
- How the article frames modifier use in a repeat-procedure scenario
- The CPT example used to illustrate the situation
Who Should Read This
- Hospital coders
- Outpatient billing staff
- Compliance professionals
- Revenue cycle teams
Codes Discussed
Modifiers Discussed
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