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Wiki Fusion biopsy denial

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alp.jeffrey

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Humana is sending a denial: Humana Medicare denied procedure code 76376 as PAYMENT IS NOT ALLOWED FOR 3D RENDERING WITH INTERPRETATION AND REPORTING (CPT 76376 & 76377) WHEN BILLED WITHOUT A CORRESPONDING BASE IMAGING PROCEDURE CODE.

We billed:
55700
76376-26
76872-26

What is wrong with it? What is a "corresponding base imaging procedure code"? I thought it'd be the 55700 but I can't find anything online about it.
 
alp.jeffrey said:
Humana is sending a denial: Humana Medicare denied procedure code 76376 as PAYMENT IS NOT ALLOWED FOR 3D RENDERING WITH INTERPRETATION AND REPORTING (CPT 76376 & 76377) WHEN BILLED WITHOUT A CORRESPONDING BASE IMAGING PROCEDURE CODE.

We billed:
55700
76376-26
76872-26

What is wrong with it? What is a "corresponding base imaging procedure code"? I thought it'd be the 55700 but I can't find anything online about it.
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Hi, I bill for these all the time. You can't bill for the 76376-26 because the radiologist that read the MRI/CT has already billed for that code and provided those services. You can only bill the 55700 and the 76872-26. 55706, mentioned above, is for saturation biopsies only and has a number of important indications that must be met (would not be appropriate for a regular fusion biopsy).

 
toria11 said:
Hi, I bill for these all the time. You can't bill for the 76376-26 because the radiologist that read the MRI/CT has already billed for that code and provided those services. You can only bill the 55700 and the 76872-26. 55706, mentioned above, is for saturation biopsies only and has a number of important indications that must be met (would not be appropriate for a regular fusion biopsy).

Click to expand...
I agree.
 
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