Tanya Posted Thu 24th of May, 2018 16:34:04 PM
A diagnostic mammo was performed and results were given the same day. A biopsy was done immediately, on the same day and we billed an ultrasound core biopsy with a post mammo. EDI is denying the post mammo because the code was billed already that day. Someone suggested using modifier 76 on the post mammo. Is that correct?
SuperCoder Answered Fri 25th of May, 2018 04:01:37 AM
Modifier 76 is for the repeat procedure or Service by Same Physician or other qualified health care professional. A provider may repeat a procedure because the patient did not respond well to the first procedure or because the first procedure was not successful. In your case, both the procedures are different, hence modifier 76 is not appropriate to use in this case.
On the other hand, as per general coding guidelines, there is no such bundling between both the procedures.
If procedures are performed in different sessions, then it can be paid until the payer policy does not restrict to do so.
It is suggested that, it will be wise to append modifier 59 with secondary procedure to describe it as distinct procedure service.
Also, check your payer policy thoroughly and follow the specific guidelines, if any.
Hope this helps!
Wish you get paid.