Wiki Any modifier i can use after exhausting 76/77???

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rosie17e

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Good evening to all,

I am new to using the AAPC forum and would like to see if anyone can help me out. I am currently working for radiology (physician side) in New York, New York (jurisdiction K) and have been working closely with my boss. She has been noticing that we get denials when we bill out multiple x-rays in a day. There are times where we bill out 3 or 4 chest x-rays(71010) in a day and the patient could probably be seen by different specialties within that day. Knowing that certain carriers will only pay for an X amount of chest x-rays, she wanted to know if after using modifiers 26, 76 or 77, 59, GC, (which is how we usually send them out) can we use another modifier after exhausting 76/77? I only ask because I want to make sure I try all my resources. I have looked for an answer other places online and have been unfortunate. I believe that there is not other modifier other than modifier 99 - which I believe it indicates multiple modifiers, but I have yet to see that modifier used at all. If anyone is able to answer this or know of a resource please respond with the link so I am able to show her.

Thank you,

Roseanne Martinez, CPC, CPMA
 
I don't think there is any modifier that will solve this - this is a common problem that is also seen by providers who submit repeat EKGs or pathology charges for multiple samples, for example. The problem is that any time there are more than two of the same procedure performed on the same date, the payer has no way of knowing which ones are valid and which ones are duplicates. In other words, the first procedure with no modifier would be paid, and the second with a 76 or 77 may be paid since it is identified as being a repeat procedure, but any additional beyond that and the payer claims systems can't distinguish if it is a duplicate or if it is in fact a third or fourth procedure, or even a corrected claim. Sometimes it helps if you can put all of the charges that have the same CPT code and date on the same claim form and hope they get it right the first time, but once you have multiple submissions or adjustments involved, it becomes impossible for the claims processors to know what is correct. So I think in these cases you will have no choice but to appeal with the medical records and point out to the payer exactly how many of these were done on that date so that they know how many of the charges to pay.
 
Use Modifier XE/XP

rosie17e said:
Good evening to all,

I am new to using the AAPC forum and would like to see if anyone can help me out. I am currently working for radiology (physician side) in New York, New York (jurisdiction K) and have been working closely with my boss. She has been noticing that we get denials when we bill out multiple x-rays in a day. There are times where we bill out 3 or 4 chest x-rays(71010) in a day and the patient could probably be seen by different specialties within that day. Knowing that certain carriers will only pay for an X amount of chest x-rays, she wanted to know if after using modifiers 26, 76 or 77, 59, GC, (which is how we usually send them out) can we use another modifier after exhausting 76/77? I only ask because I want to make sure I try all my resources. I have looked for an answer other places online and have been unfortunate. I believe that there is not other modifier other than modifier 99 - which I believe it indicates multiple modifiers, but I have yet to see that modifier used at all. If anyone is able to answer this or know of a resource please respond with the link so I am able to show her.

Thank you,

Roseanne Martinez, CPC, CPMA
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Hi there,

Yeah, you can submit claims with modifier XE (if performed at two different encounters on same dos) or XP (if performed by separate practitioner on same dos) instead of modifier 76/77. Even though some payers who follow medicare guidelines will accept the same on claim form.

Hope that helps.

Thanks

Aarif Shaikh CPC
 
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