Modifier 76 should be used for all procedures when the physician or other qualified health care professional repeats the procedure or service the same day or during the postoperative period.
This modifier indicates the claim is not a duplicate bill but is for the same procedure or service that was performed earlier.
The procedure repeated must be the same procedure or service (same procedure or service code) by the same physician or other qualifi ed health care professional.
An explanation of medical necessity for the repeat procedure or service is required by many insurance carriers
Example A 38-year-old male was admitted to the emergency department with hypotension and a stab wound of the high right anterolateral portion of the chest after an attempted robbery. Diagnostic tests were ordered and reviewed to rule out other injury and to plan the operative approach. The surgeon reviewed and assessed preexisting medical problems, laboratory studies, and all X rays and other imaging studies; evaluated the pulmonary and cardiac function; stabilized the patient’s condition; and prepared and transported the patient for emergency surgery. The physician communicated with the patient and family and coordinated care with other physicians and health care providers. At operation, through a posterolateral thoracotomy, the hemithorax was explored, the blood clot was evacuated, and a bleeding source in the lacerated lung was identifi ed and repaired. The entire thorax and all thoracic and mediastinal structures were explored to rule out other injury. Chest tubes were placed as appropriate. The next morning, the patient was returned to the operating room to repeat the procedure because of another blood clot in the hemithorax. The blood clot was evacuated, and another bleeding source in the lacerated lung was identifi ed and repaired. CPT Code(s) Billed for First Procedure: 32110 Thoracotomy; with control of traumatic hemorrhage and/or repair of lung tear CPT Code(s) Billed for Second Procedure: 32110 76.
Hope it helps.