Wiki modifiers 76 vs 59

[ahachmann]

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

 

[CodingKing]

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.

 

[thomas7331]

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.