Modifier 77

mmagness

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I have a question regarding the usage of the 77 modifier. I work for a cardiologist office and we have both cardiologists and electrophysiologists in our office. In an instance that a patient may see both doctors on the same day would the modifier 77 be appropriate or is there another modifier that may be better suited? The situation in question is where the patient was scheduled to see the cardiologist and then he has suggested that he see the electrophysiologist. Please help....
 
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Hi,

I think it would depend on the service(s) being coded. Modifier 77 would be appropriate if a "procedure" performed by one surgeon had to be repeated by another for some reason, repeat EKG's, etc. If you are billing for E/M services, then this modifier would not be used.
 

mmagness

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If it were a E/M for both a EP doctor and a cardiologist visit what modifier could be used? Cariten is suggesting that a modifier be added to the claim. I am looking in my CPT book but there is not a modifier that stands out. Any suggestions?
 
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Hi,

I've looked through my coding resources, etc. and can't find a modifier to use to unbundle e/m codes, as in your scenario. I know that you can't bill for two e/m visits for the same physician but never heard that you required a modifier in order for two different physicians to bill for e/m services. I wonder if this is payor based; as with Medi-Cal's limitation restrictions on the number of consults allowed. Do each of your providers have their own Provider #'s to bill with?

What modifier is Cariten suggesting? A -59? Up until recently, I didn't realize that it was acceptable to use Modifier -59 for services other than those typically considered "procedures". As per CCI, -59 can be used on a number of different codes, not just "procedures". Perhaps, this is something worth looking into.

Sorry I couldn't be of more help....I'll keep reading your thread to see what other coders recommend. Good Luck!
 
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