What is the difference between modifier 59 and 76?

Asked By: Dorka Nickles | Last Updated: 6th March, 2020
Category: medical health surgery
4/5 (119 Views . 29 Votes)
Modifier 59 (Distinct Procedural Service) is used to identify services or procedures performed on the same day due to special circumstances that are not normally reported together. Modifier 76 (Repeat Procedure) is used when the procedure is repeated by the same physician subsequent to the original service.

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Then, what is the 76 modifier used for?

Modifier 76 is used to report a repeat procedure or service by the same physician and is appended to the procedure to report: Repeat procedures performed on the same day. Indicate that a procedure or service was repeated subsequent to the original procedure or service.

Also Know, what is the difference between modifier 25 and 59? Modifier 25 is used to indicate a significant and separately identifiable evaluation and management (E/M) service by the same physician on the same day another procedure or service was performed. Modifier 59 is used to indicate a distinct procedural service.

In this way, what is the 59 modifier used for?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.

What is the difference between modifier 76 and 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.

38 Related Question Answers Found

What is a 78 modifier used for?

Modifier 78 Fact Sheet. Modifier 78 is used to report an unplanned return to the operating or procedure room, by the same physician, following an initial procedure for a related procedure during the post-operative period.

What is the 77 modifier?

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.

What is a 78 modifier?

Modifier 78 Definition: “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period.”

What is a 74 modifier used for?

Modifier -74 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened

Can modifier 59 and 76 be used together?


Modifier 59 (Distinct Procedural Service) is used to identify services or procedures performed on the same day due to special circumstances that are not normally reported together. Modifier 76 (Repeat Procedure) is used when the procedure is repeated by the same physician subsequent to the original service.

How do you use modifier 59?

Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.

What is a 56 modifier?

Modifier 56 indicates that a physician or qualified health care professional other than the surgeon performed the preoperative care and evaluation prior to surgery.

What is a 24 modifier?

Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.

Can I use modifier 59 twice?

If the 59 modifier is appended to either code, they will both be allowed on the claim separately. However, the 59 modifier should only be added if the two procedures are performed in distinctly separate 15 minute intervals. If the codes were performed on the same nerve, then the 59 modifier should not be used.

What is a 51 modifier?


Modifier 51 Multiple Procedures: use Modifier 51 to indicate that multiple procedures (other than E/M) were performed at the same session by the same provider. Modifier 51 is used to identify the second and subsequent procedures to third party payers.

Does modifier 59 affect reimbursement?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. However, when another already established modifier is appropriate it should be used rather than modifier 59.

Which code does the 59 modifier go on?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. One of the common misuses of this modifier is related to the portion of the definition that allows its use to describe a “different procedure or surgery.”

Can modifier 59 and Xs be used together?

Modifier 59 is not going away and will continue to be a valid modifier, according to Medicare. However, modifier 59 should NOT be used when a more appropriate modifier, like a XE, XP, XS or XU modifier, is available. Certain codes that are prone to incorrect billing may also require one of the new modifiers.

Can you use modifier 51 and 59?

Modifiers 51 and 59 are both used when multiple services are performed during a single encounter, but they serve different purposes. Modifier 51 comes into play only when two or more procedures are performed. It is not to be used when a procedure is performed along with an Evaluation and Management (E/M) service.

Does Medicare accept modifier 59?


Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. However, when another already established modifier is appropriate, it should be used rather than modifier 59.

What is a KX modifier?

Modifier KX
Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item. Documentation must be available upon request.

What does a 25 modifier mean?

DEFINING MODIFIER 25
CPT guidelines define the 25 modifier as “significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.”