Forum - Questions & Answers
Modifier 76 and 59
Should we use modifier 76 or 59 if the same procedure is done on different site by the same physician on the same day?Please explain with the source.
Example : MRI ankel and knee.
modifiers
Modifier -59 - Documentation must support a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. The most common use of CPT modifier 59 is to allow separate reimbursement for services that would normally be “bundled” by the Correct Coding Initiative (CCI) edits
Modifier 76 represents a repeat procedure (same CPT code) by the same physician and indicates when it is necessary to report a procedure repeated subsequent to the original procedure. This modifier is used on a procedure code that cannot be quantity billed.
Medicare: Inappropriate to append modifier -76 to a surgical procedure code
http://www.wpsmedicare.com/j5macpartb/training/resources/modifiers/_files/59_76.pdf