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Modifier Confusion - 76

  1. #1
    Question Modifier Confusion - 76
    Medical Coding Books
    It doesn't state in the CPT book that for a repeat procedure it has to be on the same date of service....

    Which modifier would I use for a repeat procedure on a different date of service?

    I keep getting conflicting information..frustrating.

  2. #2
    Location
    Columbia, MO
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    12,531
    Default
    unless you are in a global there is no need for a modifier, what procedure are you talking about and how many days apart?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Mod 76 confusion
    Modifier 76 (repeat proc/same surgeon/during post op) would be appropriate on something like proc 20680 when the Dr has to remove mult pins, in the same general area (ex hand), during the global--right? There's a little confusion in my office so want to get another opinion. Mod 58 would be on the 1st 20680, but then we'd need mod 76 on ea addtl 20680, correct?

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    no mod 76 is for a repeated service in a different session, it bypasses discounting, if you removed multiple pins you would use the 59 mod or the finger modifiers if they are for the fingers. Do look at the code though ( my book is in my luggage) if it is plural like "pin(s)" then the code is already multiple. Is he removing the pins in the OR? All things being equal, if it is allowed to be billed in the global and it is not a multiple code then you would use the 58 and the 59 on the second and subsequent.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    We've tried 58/59 w/ hit & miss luck depending on insurance carrier, that's why we were looking to see if there was a better mod to use. I'd remembered 76 was for 'repeat proc' but forgot it was meant to bypass the discounting. The code, 20680, doesn't use plural when referring to the hardward & he is removing the pins in an OR. So my next question, is this a code that in order to be reimbursed separately, there must be separate incisions made? Or clear documentations that he is working on separate fx's, even if done through the same incision? BTW I appreciate the help!

  6. Default
    Use 76 same procedure repeated on different dates. ex: insertion of uterine tandems and/ovoids. This is usually done days apart approximately 3X.

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default One session One CPT
    For an accurate response to surgical coding questions, please post the scrubbed operative / procedure note. That being said ...


    This comes from Encoder Pro
    When 20680 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. If two separate, unrelated incisions are performed to remove different implants, report 20680 twice and append modifier 59 to the second procedure. (Emphasis added by FTB)

    ALL ONE OPERATIVE SESSION
    If you are removing multiple pins through ONE incisions, you report 20680 only once.
    If you are removing hardware from multiple sites, through different incisions you report 20680 once per incision and use -59 modifier on second (or third) case.

    DIFFERENT OPERATIVE SESSIONS
    If you remove hardware from one site on one day, and later return to remove additional hardware from the same site or a different site you will use a -58 modifier for a staged/related procedure if the second operation is in the global period of the first.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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