Wiki 87481 and 87661

[aqibbashir@carecloud.com]

Hi,

I have a claim with KanCare Aetna Better Health Insurance. We billed procedure codes 87801, 87481-XU, and 87661-XU. The insurance processed and paid for procedure code 87801, but denied codes 87481-XU and 87661-XU, stating that the services were included in procedure 87801. I contacted the insurance for clarification, and the representative confirmed that the denial was in line with cms.gov policy, as the submitted procedure codes are not supportable. So please review

 

[TThivierge]

Hi Aqibb
It seems same body area collected swab of germs is done from. Plus same lab procedure probes in vagina canal or lips of CPT 87661 and CPT 87481. CPT 87801 is said to be used for multiple bacteria per CPT yr 2024 manual page 699.That is why only let you use CPT 87801. Now if differ areas in the body (IE :rectum vs vagina) the modifier is right but must link differ dx to define differ body areas to CPT lab used. This looks like bundling...if same body area can only do one procedure . Also if take swab or biopsies 3 or 4 times from SAME body area or organ....billed as one. Certain organs have differ section as these examples..... per dx codes D12 block of areas of Colon, Phallus parts N35 N48 N44 N42 &N46 ,Breast N80 ,Pelvic wall N72 uterus N77& N85, I45 cardiac heart, sinus area 4 areas J01 dx block.
I hope this was helpful.
Lady T