Wiki Help

[krisfelty]

Hello all,


Can anyone tell me where it is documented that a Podiatrist cannot bill for a 76942- Ultrasound guidance for needle placement? The dr I do billing for keeps billing this and keeps being denied and he is having none of that. SOoo, I need to have it in black and white to show him, once and for all. It this a carrier determined rule-or across the board??


Thanks,

cranky coder

 

[TammyHF]

For which insurance company? If Medicare which MAC region are you in because my podiatrist gets paid for 76942 by insurance.

 

[RNCPC0709]

Why is it being denied? Incidental? Provider specialty?
Also, are all carriers denying?

**************
PB

 

[krisfelty]

We are in Arizona and it is denied as not billable by Podiatrists?

 

[TammyHF]

Take a look at your state's scope of practice for podiatry. If the states scope of practice allows the podiatrists to perform such diagnostic procedures then appeal the denial you might have to go beyond the first level appeal. I am currently putting together a third level appeal for the podiatrists I work for because WPS is denying claims as out of the scope of practice for items that is in the scope of practice according the Board of Healing Arts for the state of Kansas.