Nicole Posted Tue 18th of June, 2013 19:41:41 PM
Is there a modifier or a procedure code for the following...
Patient comes into the office and has an EKG. The physician doing the EKG reviews, interprets and provides a written report. Then another physician comes in (same practice) and over reads the EKG reports done by the previous physician.
Is there something that can be billed for this?
SuperCoder Answered Wed 19th of June, 2013 11:10:05 AM
Probably not. You could try to argue for it if the second physician had specialty training needed for a specific case, and the second physician writes a full report as well. Payers may request the use of modifier 77 in that situation. Consider this quote from Medicare Claims Processing Manual, Chap. 13, Section 100.1 about tests in ERs: “Generally, carriers must pay for only one interpretation of an EKG or x-ray procedure furnished to an emergency room patient. They pay for a second interpretation (which may be identified through the use of modifier “-77”) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.”