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Modifier 77 and Medicare

  1. Default Modifier 77 and Medicare
    Exam Training Packages
    Does anyone have any info regarding 2 e/m codes by 2 different providers on the same dos? Medicare no longer wants us to use -77; I am looking for the Medicare publication with the implementation date.

  2. #2
    30.6.5 - Physicians in Group Practice
    (Rev. 1, 10-01-03)
    Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.
    Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group.

  3. #3
    The information quoted above is on page 41 of the pdf you will get by following the link. Hope this is what you were looking for.

  4. Question Modifier 77 Please Help
    Okay, I understand if the two physicians billed out an e/m code on the same day,,, not to use the 77. My question is biopsy's. One physician here will do a biopsy on site of the body and then the patient has another procedure by a different physician at the same facility same day,,, another biopsy. We have been billing the second biopsy code with a 77 but my original biopsy codes keep denying against the 77 one and we always have to appeal it. Do we need to put a 77 on both biopsy codes?

  5. Default
    Lets say the 1st Bx is of a site on the left arm by Dr A and the 2nd Bx is of a site on the left leg by Dr B

    I guess I would code the 2nd Bx with a -59 (separate site, separate service). Dr B is not repeating (re-doing) Dr A's BX, he is doing a completely different separate Bx

    I think of the -77 as a repeat of the same service/same site. Meaning Dr A did a Bx of a lesion on the left arm and the 2nd Bx by Dr B was repeated on the same site

    Does this help? If not, can you give some specifics on the 2 BXs that were done

    -77 Repeat Procedure by Another Physician: The physician may need to indicate that a basic procedure or service performed by another physician had to be repeated. This situation may be reported by adding modifier 77to the repeated procedure or service.
    Last edited by sbicknell; 06-04-2010 at 09:58 AM.

  6. #6
    Columbia, MO
    I tend to agree with sbicknell on this one. I cannot see why a biopsy would need to be repeated at the same site, so without some great documentation I do not this going over with the payer.

    Debra A. Mitchell, MSPH, CPC-H

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