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Modifier 76 on Unclassified Drugs

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Hi,

We bill for medical oncology, and use multiple dose forms of chemotherapy drugs to reach the patient's necessary dose. This involves multiple NDC's that we must report separately.Is the 76 modifier appropriate?

Please see the following scenario:
J9999 (1ST NDC# REPORTED) 400mg
J9999-76 (2ND NDC# REPORTED) 200mg

Appreciate your help.

Thanks,
Priya
 

OncologyOKC

Networker
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29
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I am not sure why you would consider using a 76 modifier on these at all, 76 is for a repeated procedure or service. You are not preforming an additional procedure you are simply dividing it out for billing purposes based on NDC#. We currently apply no additional modifier for the situation you asked about and have had no issues with the carriers. If your claims deny without a modifier I would try the 59 before I would the 76. Hope this helps.
 

shayla22

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Modifier 76 on NOC

Priya,
We have had this issue also with Medicare and Imfinzi. We bill the 500mg on 1 line and 120mg on the 2nd line and one of them gets denied as duplicate even though they are different NDC#'s. We have tried it with the 76 and it has paid but I can not find anything in writing from Medicare on this. Any help from the coding community would be much appreciated if anyone knows where we could find this information.

Thank you,
Shayla
 

snapoleon

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medicare denials with multiple ndc's.

Have you had any success with submitting with a modifier?
 

lcgjani

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We are having the same issue with Imfinzi. We billed the 120mg with the 76 mod and it still denied. We will have to appeal proving that the NDC's are different
 
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