1formissy
Guru
I audit medical claims for a payer, and there is some confusion as to a imaging facility billing CPT code 77003 with a modifier TC. (ASC facility)
Initially, I denied the claim because it is billed with CPT code 72275 and according to AMA guidelines, 77003 is included. Then they submitted a corrected claim, with only 77003-TC. I denied it again, because that is an add-on code that cannot be billed alone. (This is the original reason why they billed it with 72275 even though I was told they did not perform that service.)
The billing facility is telling me that they are only providing the fluoroscopy, and this is the reason they are billing.
I was looking at CPT code 76000 but it is driven more towards a diagnostic imaging service.
Any insight?
Initially, I denied the claim because it is billed with CPT code 72275 and according to AMA guidelines, 77003 is included. Then they submitted a corrected claim, with only 77003-TC. I denied it again, because that is an add-on code that cannot be billed alone. (This is the original reason why they billed it with 72275 even though I was told they did not perform that service.)
The billing facility is telling me that they are only providing the fluoroscopy, and this is the reason they are billing.
I was looking at CPT code 76000 but it is driven more towards a diagnostic imaging service.
Any insight?