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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Billing Question
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Post Billing Question
Author: ahoskins
Date: Sep 18, 2008 2:15 pm
When a physician bills for the palliative care on the same day as another physician, it's my understanding from the conference, that we should add a 77 modifier to the claim. Would this be the same if the claim for the palliative care service is paid first, should we also add the 77 modifier to the other physician's claim and resubmit to medicare for payment?
-AHoskins
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Re:Billing Question (by SharolHerr on 09/19/2008)
Per discussion with Dr. Phil Santa-Emma, our Medical Director:
the 77 modifier is only used if the palliative physician is part of a group where another physician from the group is seeing the patient for a non-palliative visit.
Sharol Herr, RN, MSEd: Nurse Clinician/Education Coordinator; Mt. Carmel Health Palliative Care Leadership Center, Columbus, Ohio.
+ Re:Billing Question (by ahoskins on 09/19/2008)
The physician for palliative care is in a hospitalist group with other physicians and some of the claims for him have been paid causing the claims for the other physicains to deny as a dup claim, or that the service was paid to another provider of the group. So would I be able to add the 77 modifier to the other physicians claims that did not receive payment that was not for the palliative care service?
Re:Billing Question (by PCaines on 09/23/2008)
The below reply comment is provided on behalf of:

Julie Pipke, CPC
Reimbursement Manager, Medicine
Medical College of Wisconsin

Yes, as long as both providers are listed as the same specialty with Medicare you can add the 77 modifier to whichever claim is denied. Of course the goal is to get the modifier appended on the front end prior to submission. I have instructed our inpatient abstractors to apply the 77 to both providers' services so we don't have to play games later on. Frequently when only one service has the 77 appended, Medicare ends up paying the service that has the 77 modifier appended and denying the one that doesn't. This means we have to request an appeal by adding the 77 to the second service. Keep in mind that the primary diagnosis codes for each service should be unrelated; our guidance was that the first three digits of the ICD-9 code have to be different to use the 77.

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