Wiki 76872 denied with 76942

[Partha]

Some insurances like Oxford are denying 76872 when billed with 76942 eventhough Medicare is paying during prostate biopsy. CCI edits doesnt show any bundling issue. Any thoughts ???

 

[zaidaaquino]

Each carrier has its own policies. For example, I have found that Anthem and BlueCard programs only pay on one of those two codes when billed together. In those cases, we don't appeal as it is an insurance policy. In your case, you may want to contact Oxford and ask them to provide something in writing regarding their policies on these codes.

Zaida V. Aquino, CPC