Modifier 76- A lot behind the Code (2022)

Modifier 76– an immensely important code that can be defined as a code that is used to report a repeat procedure or a service by the same physician. 

It is appended to the procedure to report the repeat of a procedure on the same day.

What are the appropriate use-cases of modifier 76? 

The appropriate uses of modifier 76 include the following, 

  • When the same physician performs the service 
  • When the procedure codes cannot be billed according to the quantity. For instance, a patient has taken two EKG services in the morning in the radiology department. As both the EKG services indicate a clinical issue, they are both to be billed at Medicare.

What are the inappropriate uses of modifier 76? 

At times, there could be inappropriate uses of modifier 76 as well. 

  • Adding to each line of service and surgical procedure code 
  • When services are repeated because of technical or equipment failure 
  • Services which are repeated due to quality control purpose 
  • When laboratory services are repeated which refers to CPT modifier 91 
  • Make sure not to report this modifier with ‘add-on’ codes denoted in CPT with a “+” sign. 

If a service is defined as an ‘add-on’ code and is repeated more than once on the same day by the same professional, then the report ‘add-on’ code on one line with a multiplier in the unit field would indicate how many times that service was performed.

  • When unplanned return to the operating room takes place to report modifier 78 
  • Unrelated procedure or service that reports modifier 79 
  • When a service or procedure has taken place more than once or any unusual event has occurred.

FAQ:

Q1. Can you use modifiers 76 and 79 together? 

Ans. Supposedly, a procedure that is appended with the code modifiers 78 and 79, cannot be appended with modifiers 76 and 79 together. 
This modifier does not need to be sent on repeat clinical diagnostic laboratory tests rather it should be submitted with modifier 91. 

Q2. How is modifier 76 billed?

Ans. The modifier 76 can be billed or used to report a procedure or service by the same physician. 
It is appended to the procedure to report repeat procedures that are performed on the exact same day.

Q3. Does modifier 76 reduce payments? 

Ans. Yes, it does so. There are multiple imaging reductions that apply as the use of modifier 76 does not indicate that the imaging procedure is done in a separate session.

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