Brief Overview of Modifier 77

Description of CPT Modifier 77

CPT modifier 77 is used to disclose a repeat procedure done by a different physician.

Basics of modifier 77

Another physician will perform the procedure or provide the service. Modifier 77 is used to recognise when a different provider applies the same operation on the same date of service and within the post-operative period of the method. Documentation explaining the situations requiring the use of this modifier is needed.

Appropriate use

• When the patient has two or more tests and more than one physician offers the explanation and notify, add modifier 77 to the expert portion of an x-ray or electrocardiogram (EKG) process.
• Payers will only refund for a subinterval of the same EKG or x-ray in extraordinary circumstances, such as a doubtful finding for which the physician conducting the initial viewpoint believes another physician’s expertise is required.
• A shift in diagnosis as a consequence of a second interpretation.

Inappropriate use

• Billing for several services that are considered packaged.
• Attach modifier 77 to evaluation and management code.

Modifier 77 example

Example No.1
Before initiating a chest tube, a chest X-ray was taken at 11:30 a.m. Because the first radiologist was inaccessible, the chest X-ray was repeated at 12:15 p.m. by another radiologist in the same group. CPT Code 71010 for Billing Radiologist A (on line 1). The claim form does not require any informational material. Radiologist B billing: CPT Code 71010-77 (on line 2). Block 19 of the CMS 1500 claim form included a clarification. Documentation included the time of each process and a brief narrative description of why the procedure was being repeated.

Example No.2
Physician A removes small glass shards from a patient’s cornea. Because Physician A has already left for the day, the patient comes back to the same clinic later that day and sees Physician B. The patient expresses concern that there is still something within his eye. Physician B explores him and discovers a small shard of glass, which he eliminates. CPT Code 65222 for Billing Surgeon A (on line 1). CPT Code 65222-77: Billing Surgeon B (on line 2). Both physicians must accept clinical notes or an operative document. Physicians should coordinate the proposal of their claims and imply a fee split in block 19 to achieve precise claims processing.

Claim submission instructions

• Each procedure should be reported on its line.
• Identify the procedure code once without modifier 77 and once with modifier 77.
• Use the unit’s field only once to imply that the procedure was conducted more than once on the same day.
• When billing for various services on the same day and the service cannot be billed, use modifier 77.
• Review the unusual situation in the narrative description (Item 19) of the CMS-1500 claim form or the EDI similar to support the use of the modifier. Paperwork must be submitted if data cannot be written in the storyline.
• A claim will be rejected if modifier 77 and the unexpected conditions are not reported in the storyline portion of the claim or the EDI equivalent.
• This modifier should be used when another physician’s routine operation or service has to be redone.
• This modifier should be used when submitting EKG understandings or X-rays that necessitate independent advice from a physician.

You can always contact us if you need assistance with your billing. We have a knowledgeable coding team that uses exact modifiers to avoid denials. Outsource medical billing services to a team that works closely with providers to reduce billing stress while increasing revenue collections. Our support team is available 24/7 to assist our clients personally, listen to their problems, and provide the best results. To learn more about our services please contact us at rcmexpertz@gmail.com

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