tci ED Coding & Reimbursement Alert - 2005 Issue 6

You Be the Coder: Clarify Modifier Choice With Payer

Question: The ED physician performed a successful reduction on a patient's hip, and 11 days later the patient returned to the ED with a dislocated hip again. The doctor again performed a reduction. The insurer is denying the claim because of the 90-day global period. Should I try reporting it again with modifier -76 or modifier -77?Kansas SubscriberAnswer: In this case, you best option is to query the payer in question directly, because your emergency department physician performed a very necessary repeat procedure. While modifier -76 (Repeat procedure by same physician) and modifier -77 (Repeat procedure by another...

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