CPT code 77076 is for a complete X-ray bone survey of an infant, used by healthcare providers to document and track this specific diagnostic procedure.
CPT code 77076 is used to describe a radiological procedure known as an X-ray bone survey specifically for infants. This procedure involves taking a series of X-ray images of an infant's bones to assess their condition. It is typically performed to detect abnormalities, fractures, or diseases affecting the skeletal system. The comprehensive nature of the survey allows healthcare providers to evaluate the overall bone health and development of the infant, ensuring any issues are identified and addressed promptly.
When dealing with CPT codes 77075 and 77076, it is important to consider the potential need for modifiers to ensure accurate billing and reimbursement. Here is a list of modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It is applicable if the radiologist is interpreting the X-rays but not providing the equipment or technical staff.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies if the facility provides the equipment and technical staff but not the interpretation of the X-rays.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the bone survey is performed in conjunction with other procedures that are not typically reported together, to indicate that the services are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same procedure is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the same procedure is repeated by a different physician on the same day. It signifies that the repeat procedure was necessary.
6. Modifier 52 (Reduced Services): This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): This modifier is used if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): While not typically used for radiology, this modifier might be applicable if the bone survey is repeated for clinical reasons on the same day.
Each modifier should be used in accordance with the specific circumstances of the service provided, and proper documentation should be maintained to support the use of any modifiers.
The CPT code 77076 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS).
Whether or not this code is reimbursed by Medicare can depend on several factors, including the specific policies of the Medicare Administrative Contractor (MAC) that governs the region where the service is provided.
Each MAC may have its own guidelines and coverage determinations that affect reimbursement. Therefore, it is essential for healthcare providers to consult the local MAC's policies and the MPFS to determine if CPT code 77076 is reimbursed in their specific area.
Additionally, providers should ensure that all necessary documentation and medical necessity criteria are met to facilitate potential reimbursement.
Discover the power of MD Clarity's RevFind software, designed to meticulously analyze your contracts and pinpoint underpayments with precision, right down to the CPT code level, including CPT code 77076. Ensure you're capturing every dollar owed by each payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
