transabdominal/transvaginal done same day

stephmescher

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Wondering if we are able to bill both the 76830- transvaginal and the 76857 (?59 modifier) limited transabdominal on the same day? The reason for the transabdominal is we are unable to locate the ovaries via the transvaginal ultrasound.
Thank you :)
 

csperoni

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While they are not NCCI edits, some carriers do have a policy to bundle. In a situation like this where there is medical necessity to perform both, I would bill both with -XU or -59 and appeal if bundled.
 

csperoni

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Some carriers do bundle and some of those carriers require a modifier in order to pay both. I THINK HealthFirst & Aetna, but could be incorrect.
It SHOULDN'T be required, but you must put it if you expect payment for both.
 

stephmescher

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While they are not NCCI edits, some carriers do have a policy to bundle. In a situation like this where there is medical necessity to perform both, I would bill both with -XU or -59 and appeal if bundled.
One last question on this- do we need to get a new order from the ordering physician or can the radiologist make the determination to do both?
 

csperoni

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One last question on this- do we need to get a new order from the ordering physician or can the radiologist make the determination to do both?
I work for a practice where our same office is ordering and performing the testing. Because I was curious, I googled and found this:
So it seems there are situations where the radiologist may be able to make the determination, based on specific circumstances (including the location, unability to reach ordering physician, etc). I would call it a "best practice" to get the additional order if it wasn't on the original.
 
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