Wiki 76817

[Shortcakecoder101]

Hi all, I'm billing the a above code with additional u/s codes. I'm always having issues getting this pd b/c of the dx. The insurance is Aetna. Can anyone lead me in the right direction.

Thx

 

[hollyw42]

Which codes are you using with that ultrasound? Is the ultrasound at the patient's confirmation visit? I know most insurance companies only pay the first initial ultrasound and consider all others inclusive unless medically indicated.

[SUB]Holly CPC CPMA COBGC[/SUB]

 

[Shortcakecoder101]

Most of the codes used are high risk pregnancy codes. Codes 76811 and 76817 usually get billed together.

 

[hollyw42]

Aetna is very very picky about which diagnosis codes they want on certain ultrasounds. Here is a link to their policy bulletin on ultrasounds. If the link doesn't work look for Clinical Policy Bulletin 0199.

http://www.aetna.com/cpb/medical/data/100_199/0199.html

 

[Shortcakecoder101]

Thank you for your help!

 

[tonyabcarr]

Modifier 59

Are you having denials when 76801 or 76811 is billed with 76817 without modifier 59?

 

[Hkhalil]

how can I resolve an error about claim rule #34; US 76817 Medicaid

 

[nielynco]

how can I resolve an error about claim rule #34; US 76817 Medicaid

And claim rule #34 is what?