Breast ultrasound in office

lromero

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Houston, TX
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Can anyone advise me on the following scenario:

Our general surgeon has an ultrasound machine in his office. Patient referred to office for consult for "mass or lump in breast", patient has not had any ultrasound done prior to confirm this. So the surgeon will ultrasound only the breast that has the mass or lump to confirm, before confirming and schedule for surgery.

The office right now charges for a higher level visit when this is done. My feeling is that he could charge for consult and the ultrasound. But out practice manager wants to make sure and does the physician.

Does anyone agree or disagree, that consult w/mod -25 and 76645 could be charged.
Any comments would help us decide.
Thanks:confused:
 

LynaeH

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My understanding would be that yes, charge the consult w/ -25 and then the ultrasound. However, we have bee running into payors that will not pay for the ultrasound if it is done in a physician's office versus sending out to a hospital or stand alone radiological facility. The reasoning we have been given is "conflict of interest"---basically that the physician may order the exam for financial reasons versus medical necessity (can they say insulting??).
 

crhunt78

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Olathe, KS
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Yes, you should use a Mod. 25 on the E/M code to show that it was seperate from the sono. There should be documentation in the patient's chart that shows that an E/M visit was done along with the sono. We do a lot of breast ultrasounds in our office.
 

lromero

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Houston, TX
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Re: Ultrasound

Do you get alot of denials from the major carriers? Or find that because of their plan you have to refer to a free standing facility?
Thanks
 

racosta

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We bill an E/M with modifier and 76645 for the ultrasound done in office. Just make sure there is seperate documentation for intrepretation and images are filed in the medical record. This has helped justify reimbursement from insurance carriers.
 
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