Wiki Keep getting same denial

[sctaylor]

We keep seeing an inclusive denial for codes 76872 and 51798. The Dr is billing 76872 for BPH and 51798 for urinary retention. Should these be appealed since they are because of separate diagnoses? What are your thoughts? Thank you!

 

[mitchellde]

different dx codes will not unbundle this and you have no reason for a 59 modifier. The 51798 is performed under ultrasound, and then you are billing another ultrasound, you can argue for different reasons, however it is the same organ involved, and the urine retention is typically a symptom of BPH. Bill only one procedure code.

 

[sctaylor]

Thank you! I have been trying to explain this to the office staff that puts in the office charges (I only bill the surgeries) and they wanted documentation. Do you have anything that I can reference to?

 

[mitchellde]

the CCI edits and the code descriptions should be all that you need.

 

[Yjrieken]

I just wanted to add to this old post that I found recent informatioin stating something different from the AAPC. You can charge for both if they are done separately and add a modifier 59. Please click on link.

https://www.aapc.com/codes/coding-newsletters/my-urology-coding-alert/reader-question-different-encounter-is-key-for-51798-and-76872-article?srsltid=AfmBOopH8gsSeX19FP5MW-4bTnwNP0G6CCZ4ZuhJ4zXeiPesnyFhr6oC

If anyone knows this is not correct, please let us know. Our provider performs the Cysto andTRUS first and then UROCUFF, and lastly the PVR, so they are not performed together, but on the same day. The information stated in the link reads "can be done at different times" or same day, different visits.