• Is It Appropriate to Append Modifier -77 to a Diagnostic Test?


    Optical coherence tomography (OCT) was performed by an ophthalmologist, who then referred the patient to a retina specialist. The retina specialist performed and interpreted an OCT as well. Can we append modifier -77 in this scenario?

    It is inappropriate to append modifier -77 to any test. It is used on procedures.
    If your specialist orders and performs another OCT, report it without any modifier. However, Medicare administrative contractors (MACs) with published local coverage determination (LCD) policies  for OCT have limited the frequency to once per month during active treatment or with rapid deterioration, and no more than one test every two months when not undergoing active treatment. The frequency edit is per patient, not per physician. If another physician performed the test within the last month, your test may be denied. Confirm frequency edits with your commercial payers that don’t follow Medicare’s guidelines.