45380 and Modifier 76

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May 2, 2012

Question:

Our surgeon performed a biopsy of colon polyp on 3/13/12. During the global period, 2 weeks later, the patient was taken back to the OR for another biopsy. We reported 45380 for the first procedure and 45380-76 for the second procedure. We received a denial from Medicare stating this was an invalid modifier. What modifier should we have used?

Answer:

First, CPT code 45380 does not have any global days. When the patient was returned to the OR 2 weeks later for the same procedure, CPT code 45380 (assuming this is correct CPT code) should have been reported without any modifiers Second, most Medicare payors do not recognize modifier 76 on surgical CPT codes during the global period. Medicare recognizes modifier 76 on surgical CPT codes on the same day as the original surgical procedure, but does not recognize on surgical CPT codes beginning the day after surgery.