Wiki 76536 Twice in One Day

[hbthompson93]

I was wondering if it's possible to charge for 76536 twice in one visit. Our ultrasound technicians do a dedicated thyroid ultrasound, but they also do a lymph mapping. I was wondering if I add a modifier XS if it would work. Otherwise we'd have to have the patient return a second time to get both charges.

 

[thomas7331]

This code has a MUE of one so will only be reimbursed once on a given date of service unless you can appeal with medical necessity for a second procedure. However, I don't believe it would be appropriate to bill this twice given what you're saying. The thyroid and lymph nodes are both structures within the same region being imaged - there's no reason to do this twice on separate days or to submit two charges on the same day as these are both are inclusive to the single code.

 

[thomas7331]

Here's a similar question that was posted on another site suggesting that the modifier 22 be used for this situation to capture the extra work of the lymph code mapping:

http://www.panaceainc.com/radiology-archive/1534-for-the-week-of-april-11-2016.html

 

[shupe888]

I was wondering if it's possible to charge for 76536 twice in one visit. Our ultrasound technicians do a dedicated thyroid ultrasound, but they also do a lymph mapping. I was wondering if I add a modifier XS if it would work. Otherwise we'd have to have the patient return a second time to get both charges.

As long as you are doing two separate studies with two separate reports you can bill the code twice. You would need to either use mod 76 or 77 depending on who reads the exams. If the same physician reads both then append 76 on second exam. If two different physicians read then use 77. Payment depends on the payer. Government payers won't pay, but some commercial payers do. Some payers will request the reports, and sometimes will pay once reviewed.