Modifier 77
When is modifier 77 used?
Modifier 77 is used to indicate that a procedure or service has been repeated by another physician or qualified healthcare professional. This modifier is crucial for proper billing and reimbursement as it helps to distinguish when a service is being performed by multiple providers.
It is essential that the documentation clearly supports the need for the repeat service and provides information on why it is being performed by a different provider.
Key concepts of modifier 77
Key points to remember when using Modifier 77 include:
1. The repeat service must be performed by a different physician or qualified healthcare professional than the one who performed the initial service.
2. The reason for the repeat service should be documented clearly in the patient’s medical record to support medical necessity.
3. Only services that are unexpected, unplanned, or required due to specific circumstances should be reported with Modifier 77.
4. Modifier 77 cannot be used for services that were a part of the original procedure’s global period unless the repeated service was beyond the usual follow-up care.
Examples of modifier 77:
Here are a few scenarios to illustrate the appropriate use of Modifier 77:
1. Scenario 1: A patient undergoes a diagnostic procedure such as a colonoscopy at a hospital. During the procedure, the primary physician encounters unexpected complications that prevent the completion of the examination. The patient is then referred to a gastroenterologist who is able to successfully complete the colonoscopy on the same day. In this scenario, the gastroenterologist would append Modifier 77 to indicate that they are repeating the procedure initiated by the primary physician. This ensures accurate documentation and billing for the repeated service.
2. Scenario 2: A patient presents to an urgent care clinic with a laceration that requires suturing. The primary care physician at the clinic performs the initial suturing but determines that the wound requires additional attention due to its complexity or risk of infection. The patient is subsequently referred to a wound care specialist for follow-up care and further suturing. In this case, the wound care specialist would use Modifier 77 to indicate that they are repeating the suturing procedure performed by the primary care physician.
3. Scenario 3: A patient undergoes a cardiac stress test at a cardiology clinic. During the test, the interpreting physician identifies an abnormality that necessitates further evaluation with a coronary angiogram. The patient is referred to an interventional cardiologist for the angiogram procedure. The interventional cardiologist would apply Modifier 77 to indicate that they are repeating the diagnostic procedure initiated by the interpreting physician to provide a more comprehensive evaluation and treatment plan for the patient.
4. Scenario 4: A patient undergoes an initial surgical procedure for a knee injury performed by Physician A. Due to complications, the patient requires a second surgery on the same knee, which is performed by Physician B. In this case, Modifier 77 would be appended to the second surgical procedure code to indicate that it was a repeat procedure by a different healthcare provider.
5. Scenario 5: A patient undergoes a diagnostic imaging test at a hospital performed by Radiologist A. The results are inconclusive, and the patient is referred to another facility where Radiologist B repeats the same imaging test for further evaluation. In this situation, Modifier 77 would be used to denote the repeated test by a different radiologist.
By incorporating Modifier 77 in these scenarios, healthcare providers can accurately communicate the need for repeating a procedure or service by another qualified professional.