Modifier 77: Appropriate Use
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.
- 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
- 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
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.
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.
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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