Appending Modifiers Properly for Post-reduction X-rays
By Erica T. Cousin, CPC, CPC-I
Q: When performing pre- and post-reduction X-rays, which modifier should we append to the post-reduction X-ray charge?
A: Consider several factors when selecting the most appropriate modifier for post-reduction X-rays, including:
- The insurance payer
- The provider ordering the X-rays
- The number of views ordered
One Provider, Different Number of Views
For example, a provider orders a pre-reduction X-ray of the elbow, minimum of three views (73080 Radiologic examination, elbow; complete, minimum of 3 views) followed by a post-reduction X-ray of the elbow, two views (73070 Radiologic examination, elbow; 2 views). The modifier appended to the post-reduction X-ray code will differ based on the patient’s primary payer.
If the primary payer is not Medicaid, append modifier 59 Distinct procedural service for the post-reduction X-ray. This modifier is appropriate for all payers when the pre-reduction X-ray differs from the post-reduction X-ray.
If the primary payer is Medicaid, and the same physician ordered both X-rays, you should append modifier 76 Repeat procedure or service by same physician or other qualified health care professional for the post-reduction X-ray.
One Provider, Same Number of Views
If the provider orders the same number of views for both the pre-reduction and post-reduction X-rays (e.g., three views for each), append modifier 76 for all payers, including Medicaid.
Second Provider, Same Number of Views
When pre- and post-reduction X-rays are ordered by different providers, but both X-ray orders are the same (e.g., three views each), append modifier 77 Repeat procedure or service by another physician or other qualified health care professional to the post-reduction X-ray code.
Erica T. Cousin, CPC, CPC-I, serves on the National Advisory Board for AAPC, Region 3. She manages the Central Charge Review department at Cornerstone Health Care, High Point, N.C. Cousin has worked in the healthcare industry for over 15 years in various capacities, including management, coding, accounts receivables follow up, and cash applications. She is a member of the Winston-Salem, N.C., local chapter.