Wiki modifiers 76 vs 59


Georgetown, Texas
Best answers
When billing for spinal cord stimulators WITH 3 LEADS plus an epiducer I have been billing as follows : 63650- LT, 63650-RT AND 63650-59.

I have recently heard that the 76 modifier should be used instead of the 59.

Can anyone shed some light on this please?

Thank you
If they are all done in the same surgical session you cant use modifier 76. Also please note there is an MUE of 2 for this code and adding a modifier will not bypass this.
Different payers have different guidelines on the usage of these modifiers. Guidelines do say that modifier 59 is now considered a modifier of last resort and should only be used if there isn't a better modifier available. My opinion regarding modifier 76 is that it should only be used for when the exact same procedure that is repeated a second time later in the same day by the same provider, such as an EKG or lab test that has to be done again, for example, because of a change in the patient's condition. Modifier 76 doesn't accurately capture a surgical or therapeutic procedure done at a separate location on the body or in a separate encounter - for this, I would use the XS, XE, XU or XP modifiers, or 59 if none of those apply. I've found this to be a less problematic approach to reimbursement than using the 76, which can cause payers some confusion when used on a surgical procedure because it suggests that the same procedure had to be repeated for some reason, rather than identifying that it was a separate procedure that happens to have the same code.