Post Op Pain Reimbursement - Payment for 76942 (x2) when billed with 64447 & 64448
I have billed Medicare (Novitas) for CPT 64447 WITH 76942 (Ultra Sound Guidance) and CPT 64448 WITH 76942 for POST OP pain after a Total Knee Replacement.
Modifier 26 is added to each CPT 76942 item listed separately on each line.
98% of the time, both 76942 codes are denied; 1 with denial code CO-151 (..excessive amt/frequency of services not supported) and the other with denial code OA-18 (duplicate services).
They are then submitted for reconsideration with the result being that only 1 pays and the other denies as a duplicate.
2 images are submitted for the 2 sites, however, the provider does his dictation for both procedures on the same procedure note.
I am looking for advice on how to get the 76942 codes to pay for both without having to appeal or suggestions for documentation to submit for successful appeal for both USG's.
Question: What is the correct way to bill for TWO CPT codes 76942 (Ultra Sound Guidance) with 64447 (Adductor canal single shot injection for a pain block) and
64448 (Adductor canal continuous catheter pain block) when performed on a single patient?
Question: Do additional modifiers need to be submitted along with the modifier 26?
Thank you for your assistance.
I have billed Medicare (Novitas) for CPT 64447 WITH 76942 (Ultra Sound Guidance) and CPT 64448 WITH 76942 for POST OP pain after a Total Knee Replacement.
Modifier 26 is added to each CPT 76942 item listed separately on each line.
98% of the time, both 76942 codes are denied; 1 with denial code CO-151 (..excessive amt/frequency of services not supported) and the other with denial code OA-18 (duplicate services).
They are then submitted for reconsideration with the result being that only 1 pays and the other denies as a duplicate.
2 images are submitted for the 2 sites, however, the provider does his dictation for both procedures on the same procedure note.
I am looking for advice on how to get the 76942 codes to pay for both without having to appeal or suggestions for documentation to submit for successful appeal for both USG's.
Question: What is the correct way to bill for TWO CPT codes 76942 (Ultra Sound Guidance) with 64447 (Adductor canal single shot injection for a pain block) and
64448 (Adductor canal continuous catheter pain block) when performed on a single patient?
Question: Do additional modifiers need to be submitted along with the modifier 26?
Thank you for your assistance.