modifier 76 is bringing me stress

VRcoder29

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I need some help . My boss feels when we do 2 ekg's in the ER that we should just multiply them by 2 . So this is what she wants us to code 93010 X 2
( they just do the interpret )

I am new here so I try not to butt in with my advice ( I have coded for several years but I am the newbie and don't want to seem like a know it all )
I had said something about putting modifier 76 on the second one and some of the girls were like " Well we used to do that but our boss insist we bill it with the quantity."
Is there a website where I can present it to her how it is beneficial to put the 76 on the 2nd procedure.I have looked just about everywhere and I think I am just confusing myself more than anything.
 

mitchellde

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I am not sure what more you can tell them. The 76 modifier will allow both to pay at the 100% rate. I am not certain that bill with quantity 2 will do the same thing, I have never billed my multiple EKGs with anything other than the 76. Look at the reimbursements they have received when billing this way.
 

VRcoder29

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thanks , I am pretty limited on what I can look at and I haven't been here long enough to figure out how to run a report. I asked one of the billers if the quantity coding was getting paid and she said "yes" So I don't know
There is a lot I can't see but if I want to bill the cpt 93010 with a 76 I shouldn't have to present 100 different forms of proof that is what you are supposed to do. I already have 2 sheets that explain why you bill with 76 from their medicare carrier and MLN .
Thanks for all your help
 

VRcoder29

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Every Medicare carrier is different . My office is apart of CGS medicare . Today I printed a sheet from our Medicare carrier and MLN matters showing that you need to use the modifier 76 . However, it seems like every insurance company is different... so who knows. I am just wanting to follow the coding guidelines.
 

morganingle

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when we bill this to medicare we usually bill 93010 & 93010-76 for 2 ekg readings but when we bill to medicaid we bill 93010 x 2...we had problems getting medicaid to pay with the 76 mod...
 

Najwa

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Payor rules trump the boss. Many practices use CMS rules as a starting point. Get to know your payor rules in your area, provide the boss with documentation. This will help build what I call the “trust factor” for newbies.
 

cas614

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Can I get some more clarification on Mod 76, I always understood this as a "repeat" modifier as in you repeated the same test/procedure on the same exact part of the body, same exact test again. I had a coworker call on a claim that was denied by Medicare where we had three 20610s, one injection on the right knee, one inj on the left knee and one inj in the shoulder. We billed them one on each line with mod 59 appended to the second two with the right diagnoses linked and a Medicare rep said to bill the shoulder one that was denied with a mod 76, which I think is incorrect since it was not a repeat but a separate procedure. Any clarification would be great, thank you.
 

mitchellde

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The 76 is incorrect in this scenario. The 76 is used when the same procedure or test is performed in a different session. When all are in the same setting then you do not use the 76. The big difference between the 76 and the 59 is that the 76 indicates a different session which will then bypass the multiple procedure discount. The 59 is for a separate service in the same session and will not bypass discounting.
 
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