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Learn how to use repeat procedure modifiers -76, -77 with this quiz

HCPro Coder Connection, November 2, 2005

Learn how to use repeat procedure modifiers -76, -77 with this quiz

Use modifier -76 (repeat procedure by same physician) or -77 (repeat procedure by another physician) to indicate that your physicians or technicians repeated a procedure or service in a separate operative session on the same day. Report the procedure code once and then report it again with modifier -76 or -77 (i.e., on two line items on the claim). Enter the number of times physicians or technicians repeated the procedure in the claim's units field on the second line item.

Note: You may report this modifier for services ordered by physicians but performed by technicians. "Report modifier -76 or -77 based on whether the physician who performs-not orders-the service is the same or different physician that performed the procedure on the same calendar date of service," says Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort Washington, MD.

Below, a brow reduction case study demonstrates when this can happen and how your facility should correctly code the procedure. Read and code the reports then click the link below to check your answers.

Operative report 1 of 2

Preoperative diagnosis: Bilateral brow ptosis
Postoperative diagnosis: Bilateral brow ptosis
Operation: Bilateral brow lift with Endotine prosthesis
Anesthesia: Local monitored anesthesia care (MAC)
Surgeon: Dr. Smith

Procedure: The 58-year-old patient was taken to the operating room, placed in supine position and sedated. One percent Xylocaine® with epinephrine was used as a forehead block. Subsequently, the head and neck were prepped and draped.

The incisions were made up in the scalp line and carried down to the bone. Dissection was then carried underneath the fascia over the bone down to the eyebrows. A small hole was made for the Endotine prosthesis. It was placed into the old hole. The forehead was elevated, placed on the hooks.

The incision was closed with 5-0 polydioxanone (PDS) and 5-0 black nylon. Dressing was applied. The patient was transferred to the recovery room in stable condition.

Operative report 2 of 2

Preoperative diagnosis: Displacement of right Endotine prosthesis
Postoperative diagnosis: Displacement of right Endotine prosthesis
Operation: Reinsertion with right brow lift
Anesthesia: Local MAC
Surgeon: Dr. Smith

Procedure: The 58-year-old patient had been taken back to the recovery room from the previous surgery. When evaluating her post-op it was noted that the right brow was significantly lower than the left. The prosthesis was felt to have popped out of the insertion site in the bone.

The patient was taken back to the operating room and sedated. The head and neck were prepped and draped. The old incision in the scalp was used and the physician deemed the prosthesis had come out. A new hole was drilled next to it. The prosthesis was placed into this and set securely. The brow lift was performed. The incision was closed with 5-0 PDS, 4-0 black nylon. Dressing and ACE® wrap were applied. The patient was then transferred to the recovery room in stable condition.

The coding

67900-50
67900-76

By appending modifier -76 to the second 67900 CPT code assignment, the hospital explains to its Medicare fiscal intermediary that it did not mistakenly duplicate the code, and that it wants to be reimbursed for the duplicate code/subsequent surgery.