Wiki CPT codes 70486 & 77011

[jessica1974]

I'm not sure if this is the correct category where this question goes but I will ask it anyway. I'm seeing a lot of denials for code 77011 computed tomography guidance for stereotactic localization when done with code 70486 computed tomography maxillofacial area without contrast material. Can anyone give me guidance as to why these two codes should not be used together? I can't find anything on the CCI edits. Thanks a bunch.

 

[JenniferB7]

Jessica,

In general, you would report 77011 (if the scan did not have to be interpreted by a radiologist) OR 70486 (if the scan was interpreted by a radiologist). You do not report both and this is based on most insurance payer guidelines. For example, look at page 9 in MedSolutions imaging guidelines: http://www.medsolutions.com/documents/guidelines/guideline_downloads/PREFACE%20to%20the%20IMAGING%20GUIDELINES.pdf

At least, that is the explanation I keep finding. Hope that helps!

Sincerely,

Jennifer M. Connell, CPC, CENTC, CPCO, CPPM, CPMA, CPB, CPC-P, CPC-I