Modifier 76 | Repeat Procedure or Service by Same Physician/Health Care Professional

Modifier 76 describes a repeat procedure or service by the same physician or another qualified healthcare professional.

1. What is modifier 76?

Modifier 76 indicates that the same provider has repeated a procedure or service. It is appended to the procedure code to indicate that the repeat procedure is different from the original procedure.

This modifier is used to avoid denials for the same procedures and to ensure proper reimbursement for the repeat procedure.

2. When to use modifier 76?

Modifier 76 is used when the same provider repeats a procedure or service that was previously performed.

This may occur when the initial procedure is unsuccessful, or the patient does not respond well to the first procedure. It may also be used when a radiology procedure is repeated to render a definitive diagnosis.

Providers often take multiple X-rays reflecting different views of the same anatomic area to better understand the patient’s condition. Modifier 76 should indicate that the repeat procedure is not the same as the original procedure.

3. Description

The official description of modifier 76 is “repeat procedure or service by the same physician or other qualified health care professional.”

4. Examples

Examples of procedures that may require modifier 76 include repeat surgeries, repeat radiology procedures, and repeat laboratory tests.

For example, if a patient has an inconclusive biopsy, the provider may repeat the biopsy to obtain a definitive diagnosis. Modifier 76 should be appended to the procedure code to indicate that the repeat biopsy is different from the initial biopsy.

5. Documentation

Providers must document the medical necessity for the repeat procedure in the patient’s medical record.

The documentation should include the reason for the repeat procedure, the results of the initial procedure, and the expected outcome of the repeat procedure. This documentation is necessary to support the use of modifier 76 and to ensure proper reimbursement for the repeat procedure.

6. Billing

To bill for a repeat procedure using modifier 76, the procedure code should be appended with modifier 76.

The provider should also include documentation of medical necessity for the repeat procedure in the patient’s medical record. The repeat procedure should be billed with the appropriate diagnosis code and other applicable modifiers.

7. Common mistakes

One common mistake medical coders make when using modifier 76 is using it for procedures that the same provider did not repeat. Ensure that the same provider performed the initial and repeat procedures before appending modifier 76.

Another common mistake is failing to document the medical necessity for the repeat procedure. Providers must document the reason for the repeat procedure in the patient’s medical record to support the use of modifier 76.

8. Other modifiers related to modifier 76

Other modifiers related to modifier 76 include modifier 77, which indicates a repeat procedure by another provider or other qualified health care professional, and modifier 59, which indicates a distinct procedural service.

9. Tips

When using modifier 76, it is essential to ensure that the provider documents the medical necessity for the repeat procedure.

The documentation should include the reason for the repeat procedure, the results of the initial procedure, and the expected outcome of the repeat procedure. In addition, ensure that the same provider performed the initial and repeat procedures before appending modifier 76.