Otolaryngology Coding Alert

Question: Can you give me an example of when modifier 76 should be used in otolaryngology practice?

Louisiana Subscriber

Answer: Modifier 76 (Repeat procedure by same physician). It may be necessary to indicate that a procedure or service was  repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service.

Note: You should not append this modifier to an E/M service. This should apply to all specialties, and is applicable in the global period.

However, most payers, including Medicare, reserve modifiers 76 and 77 (Repeat procedure by another physician) for diagnostic services such as radiology and pathology procedures only. So, for example, if a physician shoots pre and post fracture reduction x-rays, modifier 76 would be applicable. But if a physician controls an epistaxis twice in a day, the modifier 76 probably will not be successful in getting him paid. You should bill the services as 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) and 30903-59 (Distinct procedural service) to indicate a different encounter.