Modifier Code 77

Modifier code 77 represents a repeat procedure performed by a different physician on the same day. Documentation is required that explains the circumstances necessitating the use of this modifier.

Radiology Services

Plan benefits for repeat radiology services occurring on the same day will be applied based on the full eligible charge for each service.

Example 1:

A chest X-ray was taken at 11:30 a.m. prior to insertion of a chest tube. The chest X-ray was then repeated at 12:15 p.m. by another radiologist in the same group, since the first radiologist was unavailable.

Billing

Radiologist A

No explanatory material is needed on the claim form.

Radiologist B

An explanation should be documented in block 19 of the CMS 1500 claim form or in the ?comments? field of EMC. Documentation should include the time of each procedure and a short narrative description of the reason for repeating the procedure.

For the example above, the statement in block 19 or the "comments" field might read:

"1st X-ray performed by Dr. A at 11:30 a.m. prior to insertion of chest tube. 2nd X-ray performed by Dr. B at 12:15 p.m. to verify position of tube."

Surgical Services

Even though time may have passed between patient encounters, plan benefits for surgical services performed by one physician, then repeated later the same day by another physician, will be applied as though the physicians were co-surgeons (see Modifier 62, pages 27-30). Operative reports or clinical notes from both physicians will be needed to determine the appropriate payment for the service. The notes from Physician B should document the reason for the second patient encounter.

Example 2:

Physician A removes small shards of glass from the cornea of a patient's eye. Later the same day the patient returns to the same clinic and sees physician B, since Physician A has already left for the day. The patient complains that it feels like there is still something in his eye. Physician B examines him and finds a tiny shard of glass, which he then removes.

Billing

Surgeon A

Surgeon B

Note: Clinical notes or an operative report must be submitted by both physicians. To ensure accurate claims processing, the physicians should coordinate the submission of their claims and indicate a fee split in block 19 or the comments field for EMC.

Revision History