MODIFIER – 77|#learnwithdhanya #medicalcoding #medicalcodingtraining #cptmodifiers #modifiers
BASICS OF MODIFIER 77
Repeat treatment or service by another doctor. Modifier 77 is utilized to determine when the very same treatment has actually been carried out by a various supplier to the very same member on the exact same date of service or within the post-operative duration of the initial treatment. Paperwork is needed that describes the situations demanding making use of this modifier.
APPROPRIATE USE
Add modifier 77 to the expert element of an x-ray or electrocardiogram (EKG) treatment when the client has 2 or more tests and/or more than one doctor supplies the analysis and report.
Payers will compensate a 2nd analysis of the exact same EKG or x-ray just under uncommon scenarios, such as:
A doubtful finding for which the doctor carrying out the preliminary analysis thinks another doctor’s knowledge is required, or
A modification in medical diagnosis arising from a 2nd analysis
INAPPROPRIATE USE
Billing for numerous services which are thought about bundled.
Appending Modifier 77 to an assessment and management code.
CLAIM SUBMISSION INSTRUCTIONS
Report each treatment on different lines.
List the treatment code as soon as by itself and after that once again with modifier 77.
Do not utilize the systems’ field to show the treatment was carried out more than as soon as on the very same day.
Add modifier 77 when billing for numerous services on a single day and the service can not be amount billed.
Report the uncommon scenario to support making use of the modifier in the narrative description (Item 19) of the CMS-1500 claim type or the EDI equivalent. If information can not be composed in the story, documents should be sent.
Failure to report modifier 77 and the uncommon situations in the narrative part of the claim or the EDI equivalent will lead to a claim rejection.
EXAMPLES OF MODIFIER 77
EXAMPLE 1
A chest X-ray was taken at 11: 30 a.m. prior to insertion of a chest tube. The chest X-ray was then duplicated at 12: 15 p.m. by another radiologist in the exact same group, because the very first radiologist was not available. Billing Radiologist A: CPT Code 71010 (on line 1). No explanatory product is required on the claim kind. Billing Radiologist B: CPT Code 71010-77 (on line 2). A description needs to be recorded in block 19 of the CMS 1500 claim type. Documents needs to consist of the time of each treatment and a brief narrative description of the factor for duplicating the treatment.
EXAMPLE 2
Physician A gets rid of little fragments of glass from the cornea of a client’s eye. Later on the very same day the client go back to the very same center and sees doctor B, given that Physician A has actually currently left for the day. The client grumbles that it seems like there is still something in his eye. Doctor B analyzes him and discovers a small fragment of glass, which he then gets rid of. Billing Surgeon A: CPT Code 65222 (on line 1). Billing Surgeon B: CPT Code 65222-77 (on line 2). Medical notes or a personnel report should be sent by both doctors. To make sure precise claims processing, the doctors need to collaborate the submission of their claims and show a charge split in block 19.
EXAMPLE 3
A doctor sees a recipient in the emergency clinic (ER) on January 1, 2020 and orders a single view chest x-ray. The doctor examines the x-ray, deals with, and releases the recipient. While the client remained in the ER, the radiologist’s findings show the client did not have pneumonia and there was a suspicious location of the lung recommending a growth that needed even more screening. Doctor would bill the chest x-ray utilizing 71045-26. Radiologist would bill the check x-ray utilizing 71045-26/77. In addition, the narrative description field suggested suspicious location of the lung recommending a growth that needed even more screening.
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