Modifier 77 indicates that a repeat procedure performed by a different provider is not the same service but a new and distinct procedure.
What Is Modifier 77?
Modifier 77 indicates to the payer that the repeat procedure being performed is not the same service but rather a new and distinct procedure from the original one. This modifier ensures that the provider is compensated for their services.
There can be various reasons a provider may perform a repeat procedure, including the patient not responding well to the first procedure or the first procedure being unsuccessful.
Additionally, repeat procedures may be necessary in cases where a definitive diagnosis cannot be rendered from the first procedure.
In radiology, multiple views of the same anatomic area may be required to understand a patient’s condition thoroughly.
For instance, if a patient experiences chest pain or a potential fracture, the provider may order several radiology views to understand the patient’s situation fully.
In such cases, the 77 modifier should be added to the code of the repeat procedure performed by a different provider to ensure that the correct compensation is received.
The CPT book defines modifier 77 as: “Repeat procedure by another physician or other qualified health care professional.”
How To Use The 77 Modifier
Modifier 77 can be used when a different provider performs a repeat procedure after another provider has performed the initial one.
When using Modifier 77, ensure that the provider performing the repeat procedure documents the medical necessity for the repeat service.
This documentation should clearly explain why the repeat procedure was necessary and the expected outcomes.
Make sure to understand the difference between Modifier 77 and Modifier 76. In both cases, the code for the repeat procedure should be used, but Modifier 76 should be appended when the same provider performs the procedure. In contrast, Modifier 77 should be appended when a different provider performs the repeat procedure.
The 77 Modifier should not be appended to Evaluation and Management (E/M) services. E/M services are those that a provider performs to evaluate a patient’s condition and determine a course of treatment.
These services are not repeated procedures and do not require this modifier.