Forum - Questions & Answers
Dec 9th, 2014 - ddcofnj 1
What would be the best modifier to use when the doctor has performed a colonoscopy but wants to repeat it within the year because the prep/visualization was poor. The procedure WAS NOT discontinued. Thanks
Dec 9th, 2014 - rphelps 615 1
There is no modifier if the first one was not discontinued. Payment will be based on medical necessity.
Dec 9th, 2014 -
I think the statement was stated that this was not a discontinued procedure.
Dec 10th, 2014 - yml3768 31
I think that modifier -76 is typically used in the post-op period of another procedure. If the 1st colonoscopy was done a year ago, a modifier may not be needed. May just have to send documentation to prove medical necessity.
Dec 9th, 2014 -
Modifier 76(repeat procedure or service by same physician) is the only one that I see that you could use, it indicates that the exact procedure had to be repeated by the same physican. this modifier identifies a procedure or service that was repeated subsequent to the orginal procedure or service. This distinguishes the procedure or service from either a duplicate service or billing error. Payers may requie additional documentation to establish medical necessity. This modifier has been approved for hospitl outpatient use also. CMS states the the procedure must be performed in an operating room or place equipped specifically for procedures. An operating room is identified by CMS as a place of service specifically equipped and staffed for the sole purpose of perfoming porcedures. This can be a hospital operating room, ambulatory surgery center or endoscopy suite. It does not include a minor treatment room. Good Luck :)