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

Modifier 77 describes a repeat procedure by another physician or other qualified healthcare professional. It indicates that a different provider performed a procedure or service that another provider previously performed.

1. What is modifier 77?

Modifier 77 is a billing modifier that indicates that a different provider performed a procedure or service that another provider previously performed. It is used to avoid duplicate billing and to ensure that the payer is aware that the repeat procedure is not the same as the original procedure.

2. When to use the 77 modifier?

Modifier 77 should be used when a different provider repeats a procedure or service that another provider previously performed.

This may occur when the patient did not respond well to the first procedure or when the first procedure was not successful. It may also occur when a provider needs to perform a repeat radiology procedure to render a definitive diagnosis.

Providers often take multiple X-rays reflecting different views of the same anatomic area to understand the patient’s condition better.

For example, the provider may order several radiological views of those sites if a patient has chest pain or a possible fracture. In such cases, modifier 77 should be appended to the radiology code that a different provider repeats.

3. Description

The official description of modifier 77 is “repeat procedure by another physician or other qualified health care professional.”

4. Examples

Examples of procedures that may require modifier 77 include repeat radiology procedures, such as X-rays, CT scans, MRIs, and repeat surgeries or other medical procedures.

5. Documentation

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

This documentation should include the reason for the repeat procedure, the results of the previous procedure, and any other relevant information.

6. Billing

To bill for a repeat procedure using modifier 77, the provider should append the modifier to the procedure code on the claim form.

The provider should also include documentation of medical necessity for the repeat procedure.

7. Common mistakes

One common mistake that medical coders make when using modifier 77 is confusing it with modifier 76, which indicates a repeat procedure performed by the same provider.

8. Other modifiers related to the 77 modifier

Other modifiers related to modifier 77 include modifier 78, which is used to indicate an unplanned return to the operating or procedure room, and modifier 79, which is used to indicate an unrelated procedure or service performed during the same session as a previous procedure or service.

9. Tips

When using modifier 77, follow the documentation requirements and use the modifier only when a different provider performs the repeat procedure. Using the correct procedure code and including any necessary supporting documentation is also important.