The concept of modifiers is hard to gauge, and errors can occur when the descriptions of modifiers are similar with minute differences. However, in the healthcare industry, mistakes in claims can have severe repercussions on your finances and practice reputation.
This guide will help you understand modifier 77 in detail, from practical scenarios where you may apply it to its accurate usage guidelines. We will also discuss where you should not append it to avoid denials and ensure a steady cash flow.
So, without ado, let’s get started!
Modifier 77 Description and Examples
This modifier indicates a repeat procedure rendered by another healthcare provider for the same patient on the same day as the initial service.
Practical Scenarios where Modifier 77 is Applicable
Here are some practical scenarios to help you understand where modifier 77 may apply:
Multiple Physician Interpretation
Assume a scenario where a patient underwent an MRI, and the radiologist performed the technical aspects of the procedure and provided the professional component. That is, the radiologist also interpreted the image and generated a report.
However, a neuroradiologist was also consulted for a second interpretation due to the complexity of the case. Thus, the neuroradiologist will append modifier 77 while reporting the interpretation for accurate reimbursement.
Second Opinion Consultation
A patient encounters their primary care physician for a suspected diagnosis, who orders an X-ray and interprets the image. However, the patient visits a specialist for a second opinion on the same day.
The specialist also reviews the X-ray and interprets the results for the patient. Here, the specialist will add modifier 77 with the claim for X-ray interpretation to alert the insurance payer.
Surgical Planning
Modifier 77 may also apply where a patient is scheduled for a complex surgery. Here’s how! Many times, during the planning of complicated surgeries, a second surgeon is consulted for opinion. Thus, if the second surgeon reviews any MRIs, CT scans, X-rays, etc., on the same day, they would append this modifier.
Important Note: You should be careful while using modifier 77 and provide supporting documentation establishing the medical necessity of the second consultation to avoid claim denial or financial penalties.
Accurate Usage Guidelines for Modifier 77
Discussed below are this modifier’s accurate usage guidelines:
Coding Accuracy
You should append the modifier 77 with the professional component of the repeated procedure. Besides, the medical claim must include the original service and repeated procedure on separate lines. Do not forget to include the actual time, work, and units utilized for the repeated services to ensure you receive your rightful reimbursements.
Medical Necessity
Comprehensive documentation is key to getting your claim processed on the first try. The same goes for performing repeated services and appending modifier 77.
You should attach detailed medical records to your claim that clearly document why the service was repeated. This documentation establishes the appropriateness and medical necessity for another practitioner’s interpretation or review of tests.
It should also distinguish both services, including the identities of the clinician performing the initial and repeated interpretation.
Compliance
The improper use of modifier 77 may lead to claim denials, audits, financial penalties, and legal repercussions. Thus, if the provider is billing for the repeated procedure, there should be a valid reason and supporting documentation.
Besides, different insurance companies have varying coding and billing requirements and reimbursement guidelines. Thus, we advise you to properly review the specific payer guidelines to ensure compliance.
Inappropriate Usage of Modifier 77
Confusion in modifier usage may lead to inappropriate usage. Thus, here’s a list of when you should not use modifier 77 to help you better understand its proper usage:
- Avoid appending this modifier if the repeated service is rendered by the same healthcare provider.
- When tests and interpretations are performed on different dates, this modifier does not apply.
- It is also not applicable where the second healthcare provider examines the patient and requests additional procedures and tests.
Summary
This guide discussed modifier 77 in detail, including its applicable scenarios, such as second opinion, surgery planning, and multiple interpretations. Besides, we shared the accurate usage guidelines of this modifier, including compliance considerations, the importance of establishing medical necessity, and coding accuracy.
Since we understand how the concept of modifiers can make coding so much more intricate, we included scenarios where you should not append this modifier. These include; when the same physician performs the repeat procedure, when the initial and repeat procedures are performed on different dates, and when the second physician orders additional tests/procedures.
However, if you are still having trouble, outsource medical coding to specialists at MediBill MD!
Frequently Asked Questions
