Wiki 76641 with 50

[driley6@hvc.rr.com]

New ultrasound breast code 76641 when billed with a 50 modifier is being denied by Medicare. Should these code be billed twice with RT LT? Seems like more work then just adding the 50 modifier. Does anyone have any incite on this?

 

[aaron.lucas]

Yeah, 50 should really only be used for surgeries/injections, otherwise use LT/RT.

 

[balamuruganm]

HI

This document support for All four quadrant ?

if yes means we can code with RT and LT

if No mean we need to code RT ot LT



Regards,
Balamurugan M,CPC,COC,CCS

 

[mitchellde]

What does the denial state? Are you certain it is the modifier?

 

[sivagurulingam]

Hi,

For complete ultrasound breast bilaterally code with 76641 RT and 76642 LT
For limited ultrasound breast code with 76642 RT and 76642 LT

 

[balamuruganm]

Hi,

For complete ultrasound breast bilaterally code with 76641 RT and 76642 LT
For limited ultrasound breast code with 76642 RT and 76642 LT

HI sivagurulingam,

even Header ''complete ultrasound breast bilaterally'' but the document must support o' clock position or 4 quadrant otherwise must code as Limited with RT/LT modifier
EG: 12-3,3-6,6-9, and 9-12 (Four quadrant)

Regards,
Balamurugan M

 

[driley6@hvc.rr.com]

The denial says the procedure code in inconsistent with the modifier used or modifier is missing.

 

[BlancaMancilla]

The denial says the procedure code in inconsistent with the modifier used or modifier is missing.

Are you using a TC next to the 50?

 

[lnelms]

CPT 76641 description specifically states unilateral. "Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete". MUE value is 2 so you should bill two 76641 with LT & RT if bilateral.

 

[dloftin@lfmcla.com]

Are you using a TC next to the 50?

Hi we are having the same issue. Using 76641 for both breasts TC/RT--76641 TC/LT and used a 50. Medicare is still denying. Any suggestions?