Radiology Coding Alert

Modifier 59, 76, 77: Correctly Assigning Modifiers Gets Optimum Reimbursement

- Published on Wed, Mar 01, 2000
Modifiers -59 (distinct procedural service), -76 (repeat procedure by same physician) and -77 (repeat procedure by another physician) have been designed to provide Radiology Practices with a vehicle to report procedures similar to, or exactly the same as, other services performed on the same patient on the same day.

The advantages these codes offer often go unclaimed if coding professionals dont fully understand which to assign under specific circumstances. As a result, coders risk denials and their radiology practices lose the opportunity to recoup fees and costs invested in the service.

Typically, when Medicare or another carrier spots codes that are generally not reported together or that indicate a procedure has been repeated, reimbursement would be disallowed. Assigning one of these three modifiers to the service codes, however, alerts the payer that the sequence of procedures provided was medically necessary and appropriate under the circumstances.

Understanding Subtle Coding Differences

Modifier -59 is assigned only when a distinct procedural service is provided, Charlene Finchum, CPC, coding specialist supervisor for the department of radiological sciences at the University of Oklahoma Health Sciences Center in Oklahoma City, points out. CPT Codes 2000 notes that this code should be reported when a physician needs to indicate that a procedure or service was distinct or independent from other services performed on the same day, and is used when procedures arent normally reported together. Examples include similar procedures performed on two distinct organs or on separate lesions.

While this is closely related to the description for modifier -76, Finchum notes specific differences. Modifier -76 indicates that the same procedure is repeated by the same physician. For instance, maybe three x-rays are taken of the same body part to locate a fracture. This is a repeated service provided by the same doctor, and the -76 modifier would be correctly assigned.

Modifier -77 is very similar to -76, she adds, but is assigned when a repeat procedure is conducted by another physicianperhaps follow-up x-rays are taken when a second radiologist is on duty.

How to Correctly Assign Modifier -59

In my experience, modifier -59 is most often used when work is being conducted in a vascular field, says Jennifer Butler, radiology coding specialist with Arizona Medical Provider Services Inc., in Cottonwood, Ariz., which has provided billing and management services to radiology practices in Arizona for 11 years. Correctly coding services performed on different families and orders of vessels can be extremely complex, and it is important to understand how -59 applies.

One example of the proper use of -59, she [...]

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