Modifier 76 is applied for service when a similar service is performed by the same Physician or healthcare provider on the same day.
What Is Modifier 76?
Modifier 76 is applied for service when a similar service is performed by the Same Physician or healthcare provider on the same day. If multiple or identical services are performed in one day, they bundle together. CMS allows limited amounts of the unit to be billed on one date. The modifier requires to unbundle the services.
When To Use Modifier 76
You can use the 76 modifier for;
- a service that was performed on the same day.
- Services performed on the same day by the same physician.
- Injection, surgical procedures, X-rays, etc.
Description of Modifier 76
Modifier 76 is applied for service when a similar service is performed by the Same Physician or healthcare provider on the same day. If multiple or identical services are performed in one day, they bundle together. CMS allows limited amounts of the unit to be billed on one date. The modifier requires to unbundled the services.
The official description of the 76 modifier is: “Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional.”
Modifier 76 usually reports for radiology services, rendered frequently in one day. Surgical procedures can occur twice on the same day. For Instance, an EKG was performed by one physician, and the results were questionable preliminary findings.
The second interpretation or opinion requires the same physician to get a consistent result. In contrast, any surgical procedure repeats due to unavoidable circumstances, and it is appropriate to report with modifier 76 to unbundle the services.
Evaluation and management (E/M) codes are medically inappropriate and do not accept modifier 76. For one reason, only one E/M service can be performed on the same date. Another physician can report the other service if the patient encounters another reason on the same day with modifier 25 instead of modifier 76.
Medical documentation must support the medical necessity of the repeated service. The insurance or third party may deny it and check the appropriate guidelines for repeated services.
Documentation supports the medical necessity of service if repeated by the same physician on the same day. The patient’s condition reflects the significance of the service.
The patient visited the physician for shoulder pain in the morning and got a steroid injection for the pain—similarly, another encounter with the same physician for diabetes. E/M codes do not accept modifier 76, which is inappropriate to report. Modifiers 24 and 25 apply when the E/M service repeats if it is a significantly identifiable service.
The service seems unnecessary to the physician. For Instance, the patient wants to repeat the same physician’s service for a second interpretation. If Medicare denies this service, the beneficiary will be responsible for payment.
Modifier 76 attaches to unbundle the service, and modifier GA indicates that Medicare denies paying for this service. Patients are responsible for paying for the services furnished by the physician.
Modifier 76 does not apply to specific services but only when services are performed twice.
Modifier 76 does not include different services rendered by the physician. It is only appropriate when services duplicate. For example, a Doppler ultrasound of the abdomen and an Ultrasound of the abdomen were performed on the same date. Modifier 59 is appropriate for these services as they are distinct and not identical. Therefore, adding modifier 76 to unbundle these services does not become relevant.
Radiologic and surgical procedures accept modifier 76. For example, a patient had surgical removal of a foreign body in the right eye by physician A in the morning. Physician A left the office. The patient still feels irritation in the right eye and presents similarly to the office. The same physician performed surgical procedures again to remove retained contents. Modifier 76 is appropriate to bill with Physician A’s surgical procedure.
Claim reports with the separate line when modifier 76 is attached. Two units of procedure shall be denied by the insurance, like 71046×2. It is appropriate to reports such as:
- 71046-R07.9 Physician A
- 71046-76-R07.9 Physician A
If modifier 26 bills with radiology procedure, modifier 76 orders second in the line, such as 71046-26-76.
Modifier 76 does not appropriate bundled and multiple services on the same day. It is suitable to report with modifiers 59 and 51. For example, service separate bills when imaging guidance is not included in the procedure code. They may bill with modifier 59 if any crosswalk is present. Modifier 51 bills for multiple services, such as similar procedures performed on the 1st and 2nd digits. Another service appropriate to report is modifier 51.
Modifier 76 vs. Modifier 77
Modifier 76 is applied for service when a similar service is performed by the Same Physician or healthcare provider on the same day. For example, Physician A performed the procedure in the afternoon, and the same physician repeated the service in the evening.
In contrast, Modifier 77 is applicable for the distinct physician. It reports with modifier 76 when performed by the same physician, while furnished by a different physician indicates 77.
Modifier 76 vs. Modifier 59
Modifier 76 applies with service when the same physician performs a similar service or procedure on the same day to the same patient in combination with the other service.
In contrast, Modifier 59 represents the particular service performed by the physician on the same day and is usually not allowed to be billed together on the same day.