Modifier 77, 78, 79

Modifier 77

Repeat procedure by another physician

Instructions

This modifier is appended to a repeated service from other physicians.

Correct Use

• Service originally performed by another physician
• Documentation must include reason for repeat procedure
• E.g., suspicious findings in original x-ray or EKG

Incorrect Use

Not appropriate if repeated by same physician

Claim Coding Example

Physician and Treatment Description : Radiologic exam; spine, single view

CPT 72020 / Modifier 77

Radiologic exam; spine, single view

Modifier 78

Return to Operating Room for related surgery during post op period

Instructions

This modifier is appended to another surgical code for an unplanned return trip to the operating room during global post op (10 or 90 days).

Correct Use

• Append 78 modifier in first position as the pricing modifier
• E.g., Possible complications
• Payment limited to allotted intra-op services only
• Append modifier 58 if return procedure was staged or planned

Incorrect Use

If Medicare Physician Fee Schedule (MPFS) indicator list marked with "XXX", then no modifier needed as the code has no global dates

Claim Coding Example

Provider performs bypass on February 24, 2015, and then nine days later, because of a possible infectin, an unplanned return trip back to the operating room for a chest wall exploration.

Treatment Description : Coronary artery bypass

CPT 33514 / Modifier 78

Explore chest wall

35820

Modifier 79

Unrelated procedure or service by the same physician during the postoperative period.

Instructions

This modifier is used when an unrelated procedure or service, by the same physician, is performed during the postoperative period (10 or 90 day global) of the original procedure. A new post-operative period begins when the unrelated procedure is billed.

Correct Use

• Only on surgical codes
• Append modifier 79 in first position as pricing modifier
• Not necessarily needing return to operating room
• Failure to append could result in noncoverage
• For repeat procedures on same day, append modifier 76

Incorrect Use

If Medicare Physician Fee Schedule (MPFS) indicator list marked with "XXX," no modifier is needed as there are no global dates

Claim Coding Example

Provider performs right toe amputation on May 24, 2015.

On June 25, 2015, a left foot amputation surgery was medically necessary within this 90 day global period

Date Treatment Description CPT/Modifier

5/24/15 Amputation big toe, RT 28820 TA

6/25/15 Amputation foot, LT 28800 79