Wiki CPT Code 76882

[dison1974]

Is anyone else having any trouble with this code? I have looked at the LCD and our diagnosis codes are fine, but the denials are more for modifiers - either not applying or correct modifier is missing. I can't find anything that really clarifies.

Our office is doing on same day as office visit, so applying the 25 modifier to the E&M code if applicable to visit.

Thanks in advance for any advice. I am new to podiatry billing (3rd day on job).

Teralyn

 

[jmcpolin]

do they get denied if you bill the E&M without the 25 and is your doc doing the whole ultrasound or just the reading 76882-26?

 

[dison1974]

76882

Well, if we don't bill the 25 mod, the E&M gets denied as not medically necessary due to procedure, but as far as I can tell, the practice has been either trying to bill with a 59 modifier, which I'm not really sure why, and no one can really answer. Most of the time, the physician is doing whole ultrasound. Only if there is something really out of the norm, does he send out to be read. He's doing the ultrasound and interpretation himself.

I've read everything I can find, and it seems like it should just be billed out directly by itself for those he does the whole exam for as long as diagnosis is on LCD as med necessary.

I can't find anything showing that it should need a modifier at all other than the TC or 26 if he sends the test to be read by a radiologist.

I'm out of my comfort zone as I've been billing interventional cardiology and peripheral vascular procedures for the past 3 1/2 years. So, am learning something new. A bit on brain overload at this time. Thanks for your help.

Teralyn