Repeat Services on the Same Day

Claims for multiple identical services provided to an individual beneficiary on the same day may be denied as duplicate claims if it cannot be determined that these services have been performed a second (or greater) time.

Claims for repeat services may be divided into three categories, separately identifiable services, identical services and laboratory tests.

1.        In the first instance, services may be repeated at different anatomical sites. Examples include:

·        the surgical treatment of skin lesions in different areas,

·        angiography of involving different vascular families.

These services should be coded with a "59" modifier (separately identifiable service) attached to the appropriate CPT or HCPCS code, unless there is an appropriate site modifier available (e.g., "RT," "LT," "T1," etc.).

2.        The second category of services is that of identical services being repeated. Examples include:

·        follow-up x-rays (after chest tube place, central venous line placement, new onset of distress, s/p setting of fracture, etc.),

·        repeat electrocardiograms for evaluation or treatment of arrhythmia or ischemia,

·        repeat coronary angiogram or coronary artery bypass following abrupt closure of previously treated vessel.

These services should be coded by attaching a "76" or "77" modifier (by same or different provider, respectively) to the appropriate CPT or HCPCS code. When using the "76" or "77" modifiers, the reason for the repeat service should be entered in the narrative field in Item 19 (CMS-1500 form) or in the electronic notepad. Reasons may include a statement that the service was provided for:

·        comparison/comparative purposes,

·        at different times (may indicate actual time),

·        for follow-up after treatment or intervention,

·        repeat test/different intervals.

3.        The clinical laboratory tests category includes two sub-groups. The first is repeated laboratory tests on the same day to obtain subsequent test results. This would include blood tests that were performed at different intervals. These should be coded with the "91" modifier. Examples may include:

·        follow-up potassium level after treatment for hyperkalemia, or

·        repeat arterial blood gas to monitor a patient’s condition.

Specific laboratory tests that include multiple samples being drawn at different times (e.g., glucose tolerance test) should be billed using the appropriate code for the entire test, and should not be billed as multiple individual tests. This modifier should not be used (nor the service billed) when tests are rerun to confirm initial results due to testing problems with specimen or equipment, or for any other reason, when a one-time reportable result is all that is required.

The second group of laboratory tests includes tests performed involving different sites. This may occur with microbiological tests, such as bacterial cultures of separate wounds. These services should be coded using the "59" modifier attached to the appropriate HCPCS or CPT code.

In all instances when a modifier is used to code a repeat service, the first such service should be coded without the modifier, and the repeat service(s) should include the modifier.

© All current procedural terminology (CPT) codes and descriptors copyrighted by the American Medical Association.

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