Wiki 76830 and 76998

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jeanae1005

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Hello! I bill for a provider who's specialty is REPRODUCTIVE ENDOCRINOLOGY. When he preforms a 58974 (Embryo Transfer) we bill a 76830-59 or a 76998-59 with it as well. I have received denials from Aetna and UHC, where they are appending the -26 modifier to these procedures and then denying the claim due to our Dr. not being a radiologist or credentialed to read the US. My issue is, that he uses the ultasound to guide him during the procedure, therefore, reads it. Am I missing something? Are they correct? How can I code this to get correctly paid? He does one of them in the office, and the other at an Ambulatory facility.

Thanks!!!
 
We use 76948 for rtvl and 76856 for transfer.

Question:Our clinic just recently starting using an am surg center for our procedures and was curious how they are paying you? meaning are the insurance co's paying the facility fee for the rtvl's and transfer's or is the pt paying out of pocket?
 
lscire said:
We use 76948 for rtvl and 76856 for transfer.

Question:Our clinic just recently starting using an am surg center for our procedures and was curious how they are paying you? meaning are the insurance co's paying the facility fee for the rtvl's and transfer's or is the pt paying out of pocket?
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The Ambulatory Center would bill seperately for any procedures. The patient would be responsible for paying them their fees, which will be seperate from the Dr.'s fees. You should only bill for the physician fees. Hope this helps!
 
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