Wiki Prostate Biopsy

[amymariegothard]

I work for a Urology office. We perform several Prostate Biopsies. I bill it as:

55700
76872 - 26
76942 - 26/59
DX: R97.20

I bill this way because my doctor states per AUA these are billable together and I have a letter of explanation on why this is accurate for denials. However, even with the explanation, I still get denial for 76942.. I bill the doctor's fee and he bills 76872 and 76942 for the professional component. Does anyone have any suggestions of why I can not get the 76942 to pay when billed with 76872? Should I be billing the 76942?

Thanks,
Amy

I found the answer to this:

CMS has updated the 2017 version of the National Correct Coding Initiative Policy Manual with 76872 and 76942 codes bundled. In chapter 9 Radiology, Section H of the CMS NCCI website under General Policy Statements it states: "Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same or different patient encounter/(s) on the same date of service are not separately reportable.

So we are to code one or the other of CPT 76872 or 76942 based on dictation.