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Modifier 77??

  1. Question Modifier 77??
    Medical Coding Books
    If someone could give me their opinion on this claim it woudl be much appreciated. One of our physicians on 03/11 performed a 49654. The same day the patient started to hemmorrhage, and another physician in our practice took the patient back to the OR, and performed a 49560 (open incisional hernia repair) 49568 (placment of mesh for hernia) 49002 and a 36556. The second surgery was paid, but now they are requesting the money back for the 49560, and 49568 on the second surgery. I'm wondering if it's for the 77 modifier which is - Repeat Procedure by Another Physician or Other Qualified Health Care Professional. Which it was not the same procedure code specifically. Also because the second doctor is also under our tax ID i don't know if that would mae a difference. Any help you can give would be great! Thank you!

    First surgery was

    Second surgery billed like this
    49560 -77
    49568 - 77
    49002 - 59

  2. #2
    Columbia, MO
    no you cannot use the 77 on a different procedure than the first, you can use a 78 modifier for an unplanned return to the OR for a related procedure.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    If they have the same tax ID number the modifiers for the CPT codes for the second surgical encounter should have been appended with modifier 78.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

  4. Default
    Well they have a tax id for the practice, but still have individual tax id #'s also. So 78 would work as long as they are in the same practice?

  5. #5
    I suspect that since the third party payer is requesting the money back they are looking at it as same provider/group/tax ID. You might give them a call and ask. I suspect modifier 78 will take care of it.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

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