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Modifier 76

Sandra Posted Wed 02nd of January, 2013 21:53:27 PM

We use modifier 76 when we give an additional shot for rocephin in the same visit with the J code.

I have seen 76 being used with 90461 (administration) when we give more than one immunization.

Can someone verify that this is not the way modifier 76 was meant to be used ?

Thank you

SuperCoder Answered Mon 07th of January, 2013 19:36:59 PM

Hi,

We are working on this and get back soon.

Thanks for being patient.

SuperCoder Answered Mon 07th of January, 2013 20:17:00 PM

The answer depends on the insurer, but typically, that is not an example of how modifier 76 should be used. The policy for insurer Independence Blue Cross, for example, includes the following requirements: "The events precipitating the repeat of the same procedure or service by the same provider are as follows:

A change occurs in the physical status or diagnosis of the patient.
Subsequent to the initial procedure or service, a different procedure or service is performed that necessitates the repetition of the initial procedure or service for diagnostic or confirmatory purposes...." (http://medpolicy.ibx.com/policies/mpi.nsf/e94faffabc7b0da68525695e0068df65/85256aa800623d7a85257308004e139f!OpenDocument)

If your insurer maintains similar requirements, the examples you cited would not qualify for modifier 76. An example of what would qualify might be treatment of an epistaxis in the morning and then another in the afternoon (because the patient gets another nosebleed).

The examples you mention sound more like other modifiers might be more appropriate, such as modifier 59, as well as billing multiple units or add-on codes, depending on what's being done.

Sincerely,

Torrey Kim, CPC
Editor-in-Chief
Pediatric Coding Alert

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