Results 1 to 8 of 8

modifier 76 with an ED E/M code

  1. Default modifier 76 with an ED E/M code
    Medical Coding Books
    Can modifier 76 be used with an ED E/M code if the same ER doctor saw a patient twice in the same day?

    Thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,843
    Default
    76 is not allowed on E&M codes. If you are billing for the facility you will append a 27 modifier if you are billing for the physician you will combine the elements of both visits and bill one E&M.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default modifier 76 with an ED E/M code
    The reason I am asking is because I am being advised to use it on the ED E/M code due to the description of the code which states that the -76 modifier is to be used "when a physician performs a SERVICE or procedure,and the same physician has to repeat the exact same SERVICE or procedure during the global period. This modifier should be used when coding for a repeated procedure on the claim by the same physician, same day, however, it does not need to be on the same day, nor is it limited to minor procedures." I am being told that since it states "service" then it can be used on an E/M code even though the last part of the description only states "procedure".

  4. #4
    Location
    Columbia, MO
    Posts
    12,843
    Default
    The 76 is for when you repeat the service/procedure not just the code. You cannot use it on E&M because this is a service that is not repeated. If the patient comes in a second time then everything must be done exactly the same way as the first time same questions, same problem addressed, identical in every way including the plan of care and while this might be a case where both were a level 3 there is going to be some measure of difference so the same service was not repeated. For multiple E&Ms on the same day we have always been told to roll the elements together and bill one code.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    I agree with Deb. The only other modifier that you may be able to use in 24 but as she said you can only charge 1 E&M code per day per physician for the same patient.
    Tina Wosmek CPC, COSC

  6. Default 76 Modifier with E/M codes
    Thank you for the information about the 76 modifier. However, I have never heard that if a patient saw the same ER doctor twice in the same day, the two visits have to be combined and only bill for one visit. Where is that documented? It seems like to me that if a patient has to come back to the ER and the doctor has to provide services both time, he should be able to charge for both visits.

  7. #7
    Default
    is it for the same thing or something different? If it is for something different and a new evaluation and treatment is done. I do believe that you can charge a new E&M code with the 24 modifier. Of course you would need to have different dx for the 2nd visit than the first. I am not sure-that is my thought anyway. I don't do much ER coding and have never ran into that before.
    Tina Wosmek CPC, COSC

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by WATSONC View Post
    Thank you for the information about the 76 modifier. However, I have never heard that if a patient saw the same ER doctor twice in the same day, the two visits have to be combined and only bill for one visit. Where is that documented? It seems like to me that if a patient has to come back to the ER and the doctor has to provide services both time, he should be able to charge for both visits.
    Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems

    As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident).

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

    Page 43

Similar Threads

  1. Help code Urine Cath, HCPCS code and modifier
    By priceless in forum Urology
    Replies: 3
    Last Post: 05-24-2018, 05:44 PM
  2. Modifier 25 with G Code
    By gherimicheleCPC in forum Medical Coding General Discussion
    Replies: 7
    Last Post: 11-14-2017, 01:59 PM
  3. J code modifier
    By pjorwin in forum Modifiers
    Replies: 0
    Last Post: 08-19-2013, 05:34 PM
  4. Modifier 25 on E/M Code
    By dballard2004 in forum Modifiers
    Replies: 4
    Last Post: 10-09-2012, 11:49 AM
  5. Revenue code, CPt code and MOdifier
    By meeramohanakrishnan in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 07-27-2010, 05:58 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.