Modifier 77 is used to report a repeat procedure by another physician and is appended to the repeat procedure to:
Report the same service provided by another physician.
Indicate that a basic procedure or service had to be repeated.
Add modifier 77 to the professional component of an x-ray or electrocardiogram (EKG) procedure when the patient has two or more tests and/or more than one physician provides the interpretation and report.
We will reimburse a second interpretation of the same EKG or x-ray only under unusual circumstances, such as:
A questionable finding for which the physician performing the initial interpretation believes another physician's expertise is needed, or
A change in diagnosis resulting from a second interpretation
Note: Absent these circumstances, we will reimburse only the interpretation and report that directly contributed to the diagnosis and treatment of the individual patient.
Billing for multiple services which are considered bundled.
Appending Modifier 77 to an evaluation and management code.
Report each procedure on separate lines.
List the procedure code once by itself and then again with modifier 77.
Do not use the units' field to indicate the procedure was performed more than once on the same day.
Add modifier 77 when billing for multiple services on a single day and the service cannot be quantity billed.
Effective with claims received on and after February 29, 2020, failure to report modifier 77 and the unusual circumstances in the narrative portion of the claim or the EDI equivalent will result in a claim rejection.
A physician sees a beneficiary in the emergency room (ER) on January 1, 2020 and orders a single view chest x-ray. The physician reviews the x-ray, treats, and discharges the beneficiary. While the patient was in the ER, the radiologist's findings indicate the patient did not have pneumonia and there was a suspicious area of the lung suggesting a tumor that required further testing.
Physician would bill the chest x-ray using 71045 26
Radiologist would bill the check x-ray using 71045 26/77. In addition, the narrative description field indicated suspicious area of the lung suggesting a tumor that required further testing.