Wiki Billing 73721 and 73723 together

[TBunge1960]

Can a provider bill a 73721 (MRI of the knee w/o contrast) on the left knee, and also 73723 (MRI of knee w/o contrast, followed by contrast) on the right knee, both done at the same time, with different diagnosis codes? I work on the payer side; this claim had both billed, and we rejected the 73721 as being incidental to the 73723. The provider has now appealed this decision. Thanks!

 

[mhstrauss]

Can a provider bill a 73721 (MRI of the knee w/o contrast) on the left knee, and also 73723 (MRI of knee w/o contrast, followed by contrast) on the right knee, both done at the same time, with different diagnosis codes? I work on the payer side; this claim had both billed, and we rejected the 73721 as being incidental to the 73723. The provider has now appealed this decision. Thanks!

IMO, both should be allowed, as they are 2 completely different scans, IF billed correctly. My thoughts are that it should have been billed as:

73723
73721-59

Not sure if you follow Medicare guidelines, but per NCCI edits, this combo is listed as included, but with modifier allowance of "1"...

How did you know that they are of 2 different sides? Were RT/LT used on the original claims? Or did you not find that out until documentation was provided with the appeal?
If the original claim had 73723, 73721 with no modifiers, then it was an appropriate denial. I guess it all depends on which modifiers the provider submitted...

 

[TBunge1960]

Thanks for responding Megan. There were no site modifiers submitted on the initial claim, so it looks like we'll uphold the denial.