• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Help

T

TYSON1234

Guest
Messages
160
Location
Montrose, MI
Best answers
0
Anybody else having problems with BCN paying for more than u/s (code 76805).
Pt had u/s done on 9/16 to confirm her pregnancy, on 10/7 she had another one for 20 week and then on 10/21 for a follow up due to fetal abnormality. BCN is denying stating the clinical editing rules define the procedure code, modifier or place of service as inappropriate for the reported service. I called BCN informed them there's no modifier on the claim, and they stated they would resend the claim to the correct department. I just received another RA and it states the same thing. I called them again and this time they couldn't help me out. I've never had to put a modifier on any of my claims for u/s. Any suggestions would be appreciated.

Thanks
 
The US on 10/21 probably needs to be 76816 not 76805. 76816 is a follow-up US for re-evaluation of organ systems(s) suspected or confirmed to be abnormal on a previous scan.

If the US on 10/7 is also being denied, look at the reason it was ordered. Often this 20 week is to confirm due date/size/etc. in which case 76815 US limited is appropriate. Was a "detailed fetal anatomic exam" documented, in which case 76811 may be appropriate. 76805 is a comprehensive US and has specific documentation requirements as well.

A review of each US report should lead you to more appropriate code selection.
 
Thank you for the advice. The only problem I have is, back in July, according to the Ob-Gyn Coding Alert, 76811 is a second level u/s performed on a high resolution u/s used by MFM. We're to use the code 76805.
 
You must log in or register to reply here.
Top