Wiki 76856 and 76830

[hagedorny]

I just posted this question to local forum and reposting it here with hopes of any input;

We are getting denials from Aetna for 76856 Pelvic ultrasound - trans-abdominal when billing with 76830 ultrasound trans-vaginal. Non-ob scenario.
There are no CCI edits for this pair of codes.
Aetna states that 76856 is incidental to the other procedure.
Is this correct? Does anyone have the same issue? And if so how is it handled. Any input is greatly appreciated.
Thank you;

 

[williafm]

76856 and Aetna

For Aetna you have to append a modifier 59 to 76856. It's due to an edit in their system. they will pay both and they will not change the edit

 

[hagedorny]

Thank you. I felt uneasy using 59, as I wasn't sure that it really applies. I spoke to Aetna rep but that was of no help. I guess in this case there is no other option.

Thank you again.