modifiers

Difference Between Modifiers 76 and 77

For this week, I thought I’d talk about 2 common modifiers used in diagnostic radiology–modifier 76 and 77. Let’s be honest though–talking about modifiers is probably not the most exciting coding thing to talk about–but it’s important. I’ll do my best to explain it in such a way that you actually read the whole article without getting bored– 🙂

So–modifier 76. If you look at the CPT book it says-

Ok, so the keywords here are ‘Repeat Procedure’ and ‘Same Physician.”

 

Now let’s look at modifier 77:

 

The keywords to look at here are ‘Repeat Procedure‘ by “Another Physician.’

So the difference between these modifiers is that modifier 76 is for a repeat procedure by the same physician on the same day, and modifier 77 is for a repeat procedure by a different physician on the same day.

In diagnostic radiology, I would say these modifiers are most commonly used on x-rays. Sometimes the same patient might need the same x-ray taken a few times during the course of the day. It could be x-rays for broken bones or chest x-rays to monitor different issues over time.

 

Le’ts look at a very common code- 71045. This is the CPT code for a 1 view chest x-ray.

 

Say if a patient had:

A 71045 was done at 8 am- read by Dr Smith, then later the same day

A 71045- done at 2 pm- read by Dr Smith

So basically this patient had 71045 done twice the same day. To bill these out, you have to add a modifier. In this case, this is the same procedure, read by the same physician. What modifier would you use?

You would add a modifier 76 to show that it’s a repeat CPT read by same radiologist. The 76 would go on the 71045 billed at 2 pm.

 

Let’s look at another example:

Say if a patient had:

71045 done at 9 am, read by Dr Smith, then later the same day

71045 done at 2 pm ready by Dr Jones

Now which modifier would you use? You would use a modifier 77 to show that this patient had 2 separate 71045’s done the same day, but NOT read by the same dr. You would add a modifier 77 on the 71045 from 2 pm. Does this make sense? You would use these modifiers to bill out 2 separate 71045’s the same day. You’re just trying to tell the insurance company if the same radiologist read the films or not. If you forget to add these modifiers, the insurance company most likely will think you made a mistake and billed out the same exam twice and deny one.

**Just a reminder–always follow client specific guidelines and insurance specific guidelines.

Questions? Feel free to comment below or email me at mightmedicalcoding@gmail.com.

 

Thanks for reading-

Lindsay

 

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Practice Report To Code

Everyone knows that coding takes practice, right? I mean it would be really nice if we just woke up one day, and knew how to code all the different specialties. (I admit I still have nightmares about learning how to code E/M).

 

Looking back, I remember a teacher I had who used to say, “The more you practice, the better you get.” That couldn’t be more true when it comes to medical coding. If you don’t practice EVER, you just won’t become familiar with certain types of reports. The problem is though–practice reports are hard to come by. There’s not too much out there, especially for diagnostic radiology coding.

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Coding Course

My First Day Working As A Medical Coder

On the first day of my first coding job, I didn’t know what I was doing. I really didn’t. I never coded a real radiology report before. I guess I read a few in my coding classes, but it was something that wasn’t focused on.

Everything I knew about radiology was just based on my life experiences up to that point. I knew what a wrist x-ray was because I needed one before (broke my wrist rollerblading). I knew what an ultrasound was because I have kids and had my fair share of prenatal ultrasounds.

I kind of knew what an MRI was because the machine looked scary to me and I couldn’t see myself ever being brave enough to go in one if needed. I didn’t know what a CT was. Never heard of a CTA or MRA. Didn’t know what spectral doppler was. Needless to say I was confused at my first coding job. I didn’t know what any of this stuff was. I was fortunate enough to have an awesome mentor who helped me with CPT coding and even some diagnosis coding here and there.

But I know not everyone is as lucky as I was. Not everyone has a mentor. Or maybe you don’t feel comfortable asking a coworker for help. Even though I’m not a new coder anymore, I didn’t forget what it was like being new. How I was afraid of coding everything wrong. How I was afraid that I really did not know what I was doing and was not going to make it as a coder.

 

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Click Here for more info, to see class reviews and to sign up!

 

Click HERE for more info, to see class reviews and to sign up.

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Coding Course

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coding challenge

Coding Challenge 7

Please code the CPT and ICD-10-CM code for this report. This report is HIPAA compliant and does not contain PHI.

 

Exam- Right hip including pelvis 2-3 views

Date- June 4, 2018

#1111222222


Exam-Hip x-ray right including pelvis 2-3 views

Clinical History- Right hip pain

Comparison- hip x ray 2/4/17

Technique- 2 views of the right hip and 1 ap view of the pelvis was performed

Findings: Pelvis ring intact. The sacroiliac joints are symmetric. No right hip fracture or dislocation. Punctate ossific density adjacent to the right hip. Left hip unremarkable.

Soft tissue- normal

Impression:

No right hip fracture or dislocation. Punctate ossific density adjacent to the right hip most likely related to degenerative changes.

 

Thank you for referring your patient.

Go here for the answers

coding challenge

Coding Challenge 6

Please read the report below and code the CPT and the ICD-10-CM Code. Please keep in mind that these reports are designed to be as realistic as possible, but everything is HIPAA compliant so the information is not real.

*For the tomo, please use the HCPCS code.

***************************************************************

Procedure- Bilateral Diagnostic Mammogram with Tomo

History- Bilateral breast pain for 2 weeks

Technique- Full field mammography was performed. Bilateral breast tomosynthesis was preformed in the MLO and CC projections. CAD was used as an aid for interpreting this exam.

Comparison: Prior mammo from April 2017

Density- There are scattered fibroglandular densities

Findings: There is no suspicious mass, microcalcifications,  or unexplained distortions.

Impression: No dominant mass or secondary signs of malignancy within either breast. Annual screenings recommended. BIRADS ASSESSMENT- (2) Benign findings.

Signed Dr. J.

Go Here To Check Your Answers

coding challenge

Coding Challenge 5

Please code the ICD-10-CM and CPT code for this report. To check your answers, click the link at the bottom of the report.

ABC Hospital

Patient Name- Jon Doe

Date- 1/1/18

Referring Dr- Dr Smith

Exam- US Renal

—————————————————————————————————————–

Procedure- US Renal

History- Routine check of renal cysts

Technique-2D images

Findings- Complete evaluation of the right kidney. Right kidney is normal in size with no hydronephrosis. No calculus. Simple cyst measuring 1.4 x 2.1 x 3.6 located mid portion. Simple cyst #2 measuring 1.7x 1.9 x 1.6 located upper pole.

RT kidney retroperitoneal measurements- length 9.71 AP 5.04 cm. width 5.52 cm

Complete evaluation of the left kidney. The kidney is normal in size with no hydronephrosis. Complex cyst measuring 2.2x 1.2x 1.5 located mid portion. Visualized portion of the IVC are normal. Proximal and abdominal aorta obscured by bowel gas.

LT kidney retroperitoneal measurements- length 11.50 cm AP width 6.25 cam

The bladder is normal.

Prostate is normal.

Impression- No hydronephrosis. Bilateral renal cysts.

Signed by Dr Michaels 4:00 pm 1/1/18

Go here to check your answers!

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