Modifier 77

Modifier 77 | Repeat Procedure by Another Physician/Health Care Professional

Modifier 77 is applied for service when another physician or healthcare provider performs a similar service on the same day. If multiple or identical services perform in one day, they bundle together. CMS allows limited amounts of the unit to bill on one date. The modifier requires to unbundle the services.

Definition Of Modifier 77

Modifier 77 usually reports radiology services rendered frequently in one day. Surgical procedures can occur twice on the same day.

The official description of the 77 modifier is: “Repeat procedure by another Physician or other qualified health care professional.”

77 modifier
Modifier 77 Description

For Instance, EKG performs by one physician, and the results were questionable preliminary findings.

The second interpretation or opinion requires another physician to get a consistent result.

In contrast, any surgical procedure repeats due to unavoidable circumstances, and it is appropriate to report with modifier 77 to unbundle the services. 

Evaluation and management (E/M) codes do not accept the 77 modifier and are medically inappropriate.

Only one E/M service can perform on the same date for one reason.

Another physician can report the other service if the patient encounters another reason on the same day with modifier 25 instead of modifier 77.

Medical documentation must support the medical necessity of the repeated service. The insurance or third party may deny it.

Check the appropriate guidelines for repeated services. 

Modifier 77 is applied for service when another physician or healthcare provider performs a similar service on the same day.

When To Use Modifier 77 & Modifier GA

Modifier GA bills if the physician is confident that service may deny by Medicare.

The physician issues advance beneficiary notice before services render to the patient.

If Medicare denies this service, the beneficiary will be responsible for payment.

For instance, the patient wants to repeat the service by another physician for a second opinion. The service seems unnecessary to the physician.

Modifier 77 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. 

Coding Guidelines

Documentation supports the medical necessity of service if repeated by another 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 a different physician for diabetes.

E/M codes do not accept modifier 77, and it is not appropriate to report.

Modifiers 24 and 25 apply when the E/M service repeats if significantly identifiable service. 

Modifier 77 does not apply to specific services, and it is only applicable when services perform twice.

Modifier 77 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 perform on the same date.

Modifier 59 appropriates for these services as these services are distinct and not identical.

It does not become relevant to add modifier 77 to unbundle these services.

Radiologic and surgical procedures accept modifier 77.

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.

Physician B performed surgical procedures again to remove retained contents.

Modifier 77 is appropriate to bill with Physician B’s surgical procedure.

Claim reports with the separate line when modifier 77 is attached.

Two units of procedure shall deny by the insurance, like 71046×2. It appropriates to reports such as:

  • 71046-R07.9 Physician A
  • 71046-77-R07.9 Physician A

If modifier 26 bills with radiology procedure, modifier 77 orders second in the line such as 71046-26-77.

Modifier 77 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 does not include in the procedure code.

They may bill with modifier 59 if any crosswalk is present.

Modifier 51 bills for multiple services such as two similar procedures performs on the 1st digit and 2nd digit.

Another service appropriates to report with modifier 51.

Modifier 77 vs. Modifier 76

Modifier 76 is applied for service when a similar service performs 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, while furnished by a different physician indicates 77.

Billing Example

A 39-year-old male with tumors on the lumbar region presented to the emergency department with c/o constant low back pain that started two days ago.

The patient was unable to walk for 1-week.

The patient consulted with his primary care physician, who suggested go to the emergency department.

He denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.

The patient took his routine medication. The physician ordered an X-ray of the lumbar region at midnight.

X-ray findings show unremarkable findings. The patient still has pain in the lumbar region in the morning.

Another X-ray performs by physician B to assess the results again.

This case reports 72100 for the first and 72100 with modifier 77 for the second service.

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