Wiki ultrasound w/ biopsy

[jhutchens]

codes the dr used are 76872, 55700, and 76942 with a dx of elevated psa...the ultrasound and imaging were denied....any suggestions?
thank you

 

[Jashani1]

Did you bill it as 55700, 76872, 76942-59? What's the denial reason?

 

[kandigrl79]

I typically bill 55700, 76942 -26 because that's ultrasound guidance for needle placement it doesn't stipulate the approach. So if the doc did a needle biospy of the prostate and used ultrasound guidance, 76942 would be correct even if it's transrectal. 76872 is just a transrectal ultrasound, but the description doesn't stipulate that it is used to identify the site of needle entry during a biopsy (like it does for 76942), not to mention, if you look at 55700 it tells you to use 76942 for imaging guidance. No payer is going to pay for both, so I'd just use 76942, that's just what I think anyway.

 

[Jashani1]

I bill all three and they get paid. I bill them in the order that I typed on the previous email.

 

[zaidaaquino]

The American Urological Association has a letter you can print out and attach as part of your appeal to the insurance company in question. It's directed to the Medical Director and has a very thorough explanation of why each of these three codes is billable and payable. Some insurances have their own guidelines. For example, we have a couple where they won't pay on 76872 unless we use modifier -59. But you should definitely appeal your denial.

Zaida V. Aquino, CPC

 

[jhutchens]

thank you...everyone for your help

 

[jhutchens]

do you know where on their website this is found?
thank you

 

[LDH CPC CPMA]

I bill all three and they get paid and I don't use a modifier.

 

[zaidaaquino]

In reply to your question about where to locate the letter on auanet.org, go to Practice Resources and then to Appeal Letters. Next choose the letter that says Transrectal Ultrasound Prostate Biopsy. I hope you win your appeals Sorry for the late reply.

Zaida V Aquino, CPC