Wiki Anca CPC

[ancaion]

We billed an inpatient consultation for maternal fetal medicine with CPT 99252 and an ultrasound with CPT 76816 with modifier 26. BCBS IL denied the ultrasound as bundled. Any ideas about what should we use?

Thanks

 

[mitchellde]

Just guessing here but they are probably considering the ultrasound as necessary for the visit and not significant from the visit, if you can show that the visit is in fact separately identifiable then use a 25 modifier on the visit, and sometimes with BCBS you need a 59 on the procedure ( in addition to the 26), I have never figured out why.

 

[ancaion]

Thank you Debra, we will try this.

 

[Biller385]

If you go to BCBSIL website and under providers they have a list of things. Go to the dropdown for provider tool and in the list is clear claim (CCI). You can put in all of your codes and see which ones they will pay. I think they give a rational for the denied ones. You can play around with the codes by putting in different modifiers to see which one they want.

Cathy