Wiki U/S denied because it was billed by a separate provider/practice on the same DOS

[lisa30052@gmail.com]

We performed a scrotal ultrasound (76870) and UHC denied the claim stating another practitioner billed the same code on the same DOS.

The patient was seen by another provider in another practice, on the same date of service, and had the U/S (76870).

He was then referred to us and was seen the same day and we also performed the same U/S (76870).

Is this a valid denial? Is there a way we can get reimbursed for our provider performing the U/S?

 

[carlystur]

Personally, I would love to know the reason behind the referral after they had already performed the U/S and billed for it themselves.

 

[thomas7331]

I agree, I'd want to know why the test had to be repeated. But if in fact both test were necessary, then the second one should be billed with a modifier 77 to indicate this. That may or may not resolve the denial, because the payer may have a payment policy limiting how many of a particular test they will reimburse per day.