Modifier 77: Appropriate Use

September 13, 2020Modifiers

Basics of Modifier 77

Repeat procedure or service by another physician. Modifier 77 is used to identify when the same procedure has been performed by a different provider to the same member on the same date of service or within the post-operative period of the original procedure. Documentation is required that explains the circumstances necessitating the use of this modifier.

Appropriate Use

Add modifier 77 to the professional component of an x-ray or electrocardiogram (EKG) procedure when the patient has two or more tests and/or more than one physician provides the interpretation and report.
- Payers will reimburse a second interpretation of the same EKG or x-ray only under unusual circumstances, such as:
A questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed, or
A change in diagnosis resulting from a second interpretation

Inappropriate Use

Billing for multiple services which are considered bundled.
Appending Modifier 77 to an evaluation and management code.

Claim Submission Instructions

Report each procedure on separate lines.
List the procedure code once by itself and then again with modifier 77.
Do not use the units’ field to indicate the procedure was performed more than once on the same day.
Add modifier 77 when billing for multiple services on a single day and the service cannot be quantity billed.
Report the unusual circumstance to support the use of the modifier in the narrative description (Item 19) of the CMS-1500 claim form or the EDI equivalent. If data cannot be written in the narrative, documentation must be submitted.
Failure to report modifier 77 and the unusual circumstances in the narrative portion of the claim or the EDI equivalent will result in a claim rejection.

Examples of Modifier 77

Example 1

A chest X-ray was taken at 11:30 a.m. prior to insertion of a chest tube. The chest X-ray was then repeated at 12:15 p.m. by another radiologist in the same group, since the first radiologist was unavailable. Billing Radiologist A: CPT Code 71010 (on line 1). No explanatory material is needed on the claim form. Billing Radiologist B: CPT Code 71010-77 (on line 2). An explanation should be documented in block 19 of the CMS 1500 claim form. Documentation should include the time of each procedure and a short narrative description of the reason for repeating the procedure.

Example 2

Physician A removes small shards of glass from the cornea of a patient’s eye. Later the same day the patient returns to the same clinic and sees physician B, since Physician A has already left for the day. The patient complains that it feels like there is still something in his eye. Physician B examines him and finds a tiny shard of glass, which he then removes. Billing Surgeon A: CPT Code 65222 (on line 1). Billing Surgeon B: CPT Code 65222-77 (on line 2). Clinical notes or an operative report must be submitted by both physicians. To ensure accurate claims processing, the physicians should coordinate the submission of their claims and indicate a fee split in block 19.

Example 3

A physician sees a beneficiary in the emergency room (ER) on January 1, 2020 and orders a single view chest x-ray. The physician reviews the x-ray, treats, and discharges the beneficiary. While the patient was in the ER, the radiologist’s findings indicate the patient did not have pneumonia and there was a suspicious area of the lung suggesting a tumor that required further testing. Physician would bill the chest x-ray using 71045-26. Radiologist would bill the check x-ray using 71045-26/77. In addition, the narrative description field indicated suspicious area of the lung suggesting a tumor that required further testing.

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