Proper Billing of the Same Surgical Procedure Code Multiple Times on the Same Day

WPS Medicare does not recognize Modifier 76 for surgery codes. To properly report the performance of multiple instances of the same surgical procedure code on the same day by the same provider, review the description of the procedure code. If the surgery is one that may be performed more than one time on the same day, a provider can bill multiple units if WPS Medicare's claims processing system will allow it. If it is not known if the surgery code can be quantity billed, a provider may call WPS Medicare Customer Service and ask "will your claims processing system allow us to quantity bill code XXXXX?" If the code cannot be quantity billed, you will need to bill each surgery on a separate line on the same claim and provide narrative information for each line, or at claim level, that indicates the number of times the surgical procedure was performed. For example, "code XXXXX performed a total of three times on mm-dd-yyyy."

We are aware that some providers inappropriately append Modifier 59 to indicate a distinct procedure was performed when a surgical procedure is performed multiple times on the same day by the same provider for the same Medicare beneficiary. Please be advised that Modifier 59 may only be used when no other modifier is appropriate and when the code combination appears on the National Correct Coding Initiative (NCCI) edit tables located on the Centers for Medicare & Medicaid Services' (CMS) Website.

If a provider receives duplicate denials for a surgical procedure performed multiple times on the same day by the same provider for the same beneficiary, he/she must request a Redetermination in order for WPS Medicare to consider the denied service for reimbursement. Submit supporting documentation to justify the service was performed multiple times on the same day by the same provider for the same beneficiary.

Page Last Updated: Friday, 06-Nov-2009 14:06:54 CST