Radiology Coding Alert

Question: Many times, a chest x-ray is done in the morning and then repeated in the afternoon. These may be read by different radiologists. Do we need to document shift change in order to support the use of modifier -77? We also had a situation in which one radiologist became sick and another stepped in to cover for him. Do we have to document this as well?

Indiana Subscriber


Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.         Answer: This is a common occurrence, and most payers recognize it as such. The documentation needs to indicate why two x-rays were done on the same day and were read by two different radiologists (which is the function of modifier -77 [repeat procedure by another physician]). You do not need to provide an explanation of the circumstances that caused the second radiologist to become involved.

This situation might occur if a newborn is suffering from respiratory stress syndrome (769), for instance. It may be medically necessary to perform four or five chest x-rays on the same day to assess how well the infants lungs are functioning. The first x-ray would be reported using 71010 (radiologic examination, chest; single view, frontal). Subsequent x-rays, read by a different radiologist, would be assigned 71010-77. Of course, if the same radiologist read any of these x-rays, they would be coded 71010-76. Modifier -76 describes repeat procedure by same physician.

Another example may occur in the emergency department if a trauma patient presents with a broken arm (ICD-9 812.40 , fracture of humerus, lower end, closed unspecified part). An x-ray may be taken to locate the fracture (73060, radiologic examination; humerus, minimum of two views) and then repeated after the cast had been applied to determine that the bone had been set correctly.

In this instance, the initial x-ray would be coded 73060, while the second would be assigned 73060-77 if a different radiologist read the films, or 73060-76 if the same radiologist performed this service.

Coders should recognize that payers in some areas do not allow the use of modifiers -76 and -77. Instead, alternative systems have been implemented. As always, follow the instructions of your local payers.