Wiki Second Posting - Prostate Biopsy U/S

[Partha]

This has been discussed in the forum & backed by CPT Assistant when the transrectal US is a proper diagnostic one and distinctly different from the US guidance for prostate biopsy we can code 76872 in addition to 55700 & 76942, but what we are seeing is most payers deny 76872 as bundled?

Any inputs will be greatly appreciated!

 

[Lisa Bledsoe]

Many payors may need modifier -59 on 76872 to bypass their edits, if appropriate.

 

[Partha]

Thanks - but will it be ok to use mod 59 when there is no CCI edit?

 

[Lisa Bledsoe]

I looked at the claim edits for a couple of the payors and they will accept -59. Keep in mind that commercial carriers don't alwasy follow CCI edits.

 

[Partha]

Commercials...

...Agreed commercials have different edits and don't necessarily follow Medicare's CCI edits but how will we check/apply on our claims what commercials follow...?