Wiki Medicaid and 76817 with twins

[zaida120]

Have patient with twins and physician did ultrasound on both fetuses. Normally we can submit 76817 with 59 modifier. Problem is Medicaid does not recognize 59 modifier so a 51 modifier was appended to the second code. Code correct states that we can't use a 51 modifier on 76817. When I checked in the CPT 2009 manual it does not show 76817 as 51 mod exempt. Any thoughts?

Here is what we are trying to submit:
76817
76817-51

Thanks for your help!

 

[gladys font]

You did not mention whether this is a transvaginal or transabdominal u/s. If the physician did a transvaginal 76817 we only code it once, no matter how many fetuses are in the womb. If I'm wrong please correct me.

GFontm CPC

 

[amjordan]

We bill using units when an add on code is not available. The diagnosis used must be the twin diagnosis. Since 76817 is for a transvaginal, then you only bill that once.

If you have access to the CPT Assistant March 2003, it has excellent information regarding billing of OB ultrasounds.

 

[zaida120]

My apologies it was CPT 76816: transabdominal. Where exactly can I get the CPT Assistant articles?
Thank you for your help!

 

[amjordan]

It is a periodical put out by the AMA. You can purchase an Archive CD with all of the past issues, which is what I use. They also have the past issues that you can purchase.