Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 13, 2003 PDF

The key to getting two E/M services paid in the ER is to know your modifiers, Steve Verno says. If a patient is seen by the same physician twice in one day, you'd use modifier -76 (Repeat procedure by same physician) if you bill two E/M services separately instead of combining them.
 
"We have used them in the past where the PT came in in the morning and saw one of our physicians, and then at five in the afternoon is seen by the same physician for a different reason," Verno says.
 
But if two different doctors see the same patient in the ER, you bill using modifier -77 (Repeat procedure by another physician) to indicate separate doctors, he adds.
 
Whether you combine these visits or bill them separately in the ER depends on the coder, Verno says. If it's two different docs in the ER, he'd advocate billing them separately but combining two visits to the same doctor and billing at a higher level.