Hello,
I was asked to call Medicare today on a claim where service 76870 (Ultrasound, scrotum and contents) was denied because the POS was 12. The service was done in the patient's home as he is homebound. I called Medicare to ask them to reprocess, and the rep told me that Medicare won't pay for that code with POS 12. I asked her for documentation that says this and also says what POS Medicare WILL accept, and was told that it is an "internal reference only" so she couldn't share the information. When I pressed her she told me to contact our biller/coder to find out how to bill the claim "correctly." (We don't do the coding in my office...the physicians code for themselves.) Is there a resource somewhere that details what POS Medicare allows to be billed for each CPT code? I often get the "contact your biller/coder, we're not billers/coders and can't tell you how to do things", from Medicare, but it has started to feel like a smokescreen so they can turn the issue back on us. I don't have as much experience as I'd like actually coding, but I don't see any issue with how the doctor coded this service. Any advice is appreciated!
I was asked to call Medicare today on a claim where service 76870 (Ultrasound, scrotum and contents) was denied because the POS was 12. The service was done in the patient's home as he is homebound. I called Medicare to ask them to reprocess, and the rep told me that Medicare won't pay for that code with POS 12. I asked her for documentation that says this and also says what POS Medicare WILL accept, and was told that it is an "internal reference only" so she couldn't share the information. When I pressed her she told me to contact our biller/coder to find out how to bill the claim "correctly." (We don't do the coding in my office...the physicians code for themselves.) Is there a resource somewhere that details what POS Medicare allows to be billed for each CPT code? I often get the "contact your biller/coder, we're not billers/coders and can't tell you how to do things", from Medicare, but it has started to feel like a smokescreen so they can turn the issue back on us. I don't have as much experience as I'd like actually coding, but I don't see any issue with how the doctor coded this service. Any advice is appreciated!