April 15, 2008
Inappropriate Use of Modifiers 76 and 77
We have seen an increase recently in use of the -77 and -76 modifiers with E&M services to bypass edits related to concurrent care by two physicians of the same specialty on the same day. Communication with CMS Central Office has confirmed that this is an inappropriate use of these modifiers. Although the CMS Manual system doesn’t clearly state this, per se, the intent is and always has been for these modifiers to apply only to procedures, not to E&M services. Revised language making this clear will be coming out in a Manual revision later this year, and a forthcoming NCCI update will also make this clear. In the meantime, providers are encouraged to not append the 76 and 77 modifiers to claims for E&M services. Future audits of such inappropriate use of the modifiers on claims will likely result in recoupment of monies incorrectly paid.
