Wiki 76376 and Necessities

[JCaillouet]

Hello everyone! Long time listener, first time poster. *ducks for the lame joke*

Here's the thing. I work with a group of physicians. A part of their Prostate Biopsy protocols use the code 76376 or 3D rendering. The problem I'm running into is that the 3D rendering is being denied for not medically necessary.

Is there a link with a letter which states the necessity of the 3D rendering or links I can use to draft a letter?

Thanks!

 

[donnajrichmond]

With a medical necessity denial it sounds like the payer has a local policy. Some Medicare contractors require 2 diagnoses with 76376 or 76377 - one giving the patient's disease or symptom, and a 2nd from 793.x to indicate that the base scan wasn't sufficient.
Have you checked for an LCD or policy on other payer's sites?

 

[JCaillouet]

With a medical necessity denial it sounds like the payer has a local policy. Some Medicare contractors require 2 diagnoses with 76376 or 76377 - one giving the patient's disease or symptom, and a 2nd from 793.x to indicate that the base scan wasn't sufficient.
Have you checked for an LCD or policy on other payer's sites?

We're doing so now. A part of our problem deals with one payor which bundles this payment in with other codes related to a biopsy.

 

[JCaillouet]

Apologies for the bump but is there any other resources we can use to draft a letter approving this? Medicare does pay for the 76376 per LCD's but we need information to convince payors to cease bundling the payment.