Your CPT Questions

Reprinted from October 2000 CAP TODAY

Q: Our practice has been investigating modifier -76, Repeat Procedure by Same Physician. Should we use modifier -76 when we receive multiple surgical pathology specimens from the same patient? For example, should we use -76 when we receive multiple skin biopsies on the same day from a single patient?

A: The -76 modifier is not appropriate for reporting multiple surgical pathology specimens. The American Medical Association’s CPT book defines the -76 modifier with the following explanation: “The physician may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding the modifier ‘-76’ to the repeated procedure/service or the separate five digit modifier code 09976 may be used.”

This modifier typically is used by surgeons who must repeat a surgical procedure in a different operative session. Health Care Financing Administration program memorandum A-99-41 states, “Modifier -76 is used to indicate that a procedure or service was repeated in a separate operative session on the same day by the same physician.” The -76 modifier indicates that an initial procedure code has not been mistakenly reported twice and therefore would not be appropriate to report multiple surgical pathology specimens.

Using the aforementioned example, if you receive multiple skin specimens that exceed the daily national maximum units of service edits for a patient or more restrictive local Medicare carrier edits, then report the units up to the maximum without a modifier. Each unit over the maximum should be reported with the -59 modifier to receive reimbursement. For more information about the maximum units of service edits, see the “Capitol Scan” item “Limits set on outpatient CPT code use,” page 108.

Q: When performing a fine-needle aspiration, is it appropriate to use an Evaluation and Management code in addition to the FNA codes? If so, which E/M codes can be reported?

A: If pathologists perform an FNA (88170 or 88171), they can use the appropriate E/M code from the Office or Other Outpatient Consultations section of the CPT book, depending on the level of service provided and the time spent with the patient. This section of the CPT book defines office consultations for new or established patients as requiring three key components: “a problem focused history; a problem focused examination; and straightforward medical decision making.” Further, “Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.”

Code 99241 can be reported with FNA code 88170 or 88171 when the presenting problem(s) are self limited or minor and face-to-face time—that is, the E/M component of the service—with the patient and/or family usually is 15 minutes. The time for performing the FNA procedure is not included as part of the E/M codes. Code 99242 is used when the presenting problem(s) are of low severity and the physician usually spends 30 minutes face-to-face with the patient and/or the patient's family.

The codes and descriptions listed here are from Current Procedural Terminology, a copyrighted publication of the American Medical Association. To purchase CPT books, call the AMA at (800) 621-8335.