76377/76378

a_starra

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Does anyone know if 76376/76377 is considered inclusive of 93303,99304,93307 when coded together for the same day of service?
 

kevbshields

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Louisville, KY
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It is not inclusive. However, I have a difficult time substantiating it in the record. What are your providers including in their reports to justify it?

You can always Pvt me if you want.

Thanks!
 

Davistm

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Moore, OK
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Agree with Kevin. The issue is medical necessity. In your case, what information does the treating physician need that cannot be provided by the echocardiogram and Doppler add-ons?

Our MAC is TrailBlazer and they have issued specific guidance on these codes. The order from the treating physician must specifically request a 3D rendering, must state exactly what information is needed and why. The test report must include a paragraph on 3D rendering that addresses each element of information requested by the treating physician. If this documentation is not in the medical record then the service is considered not medically necessary. Our MAC expects to see these codes "very infrequently".

I would be very sceptical of frequent or what appears as routine reporting of these codes.

Terry
 

a_starra

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you refer to MAC.. unfortunately, I'm not familiar with that program. Do you know where I may find these guidelines to provide to the docs on documentation.

Thank you for your reply,
Astara
 
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