Wiki Modifier 76 question

[Staykey]

In our derm practice we are having a disagreement about what modifier to use for the same procedure code done twice at the same time on different areas of the body. Pt had removal of 2 subcutaneous cysts, one on the chest & one on the back. What modifier would be used on the second cyst removal? Half the staff say to bill with modifier 76 & the others say modifier 59. Can anyone help us out with this? Thank you in advance!

 

[thomas7331]

I have read that some payer policies do require modifier 76 in this situation, but in my opinion, the 59 (or XS) modifier is more correct. Modifier 76 is defined as a 'repeat procedure', which is an identical procedure that is done a second time on the same date. In the case you describe, the provider is not repeating the procedure - these are actually two separate and distinct procedures that happen to be coded with the same CPT. I feel that the modifier 59/XS description more accurately represents this, and this is what has been used my all of the payers and practices I've worked with throughout my career, and generally without any issues as far as denials or audits findings.

 

[Staykey]

I have read that some payer policies do require modifier 76 in this situation, but in my opinion, the 59 (or XS) modifier is more correct. Modifier 76 is defined as a 'repeat procedure', which is an identical procedure that is done a second time on the same date. In the case you describe, the provider is not repeating the procedure - these are actually two separate and distinct procedures that happen to be coded with the same CPT. I feel that the modifier 59/XS description more accurately represents this, and this is what has been used my all of the payers and practices I've worked with throughout my career, and generally without any issues as far as denials or audits findings.

Thank you so much. I agree with not using the 76 because it's not the same anatomical location.