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Thread: CPT codes 10022, 76536, & 76942

  1. #1

    Default CPT codes 10022, 76536, & 76942

    I work with an Endocrinologist who likes to bill CPT 10022, 76536, & 76942 bilaterally and with 2 units. From my understanding you can't bill CPT 76942 bil or with more than 1 unit. I'm unable to find any information on CPT 10022 or 76536, does anyone have any helpful inforamtion.

  2. #2
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Default

    I agree with you about 76942.

    I can't find anything that says you can't bill 10022 with a "50", but because of the code description (no anatomical sites noted), I think that Modifier "59" would be a better choice for any add'l FNAs done at saem session.

    To the issue of 76536, is this being used at the same session as the above noted CPTs?
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    okay......if Ultrasonic Guidance is being used to place the needle for the FNA, I do not believe that you should be coding for a separate Ultrasound done during the same session.
    Last edited by magnolia1; 01-12-2009 at 01:57 PM. Reason: spelling
    Karen Maloney, CPC
    Data Quality Specialist

  4. #4

    Default

    Yes 76536 is being billed the same way. Thanks for the help with 10022. I was thinking of add mod 59 but didn't want to do so unless I was perfectly clear about the mod 50 issue.

  5. #5

    Default

    Yes same session sorry for the double post.

  6. #6

    Default reimbursement for 10022

    I also work with an Endocrinoligist who bills the 10022. We bill this code on a single line using the Modifiers 76 & 59. Recently I was told by one of the local insurance carriers that this code should be billed on seperate lines.

    The Doctor bills for multiple nodule aspirations sometimes as many as 10.
    Have you ever billed for this many and what is the reimbursemnt? We have been receiving full reimbursement for all units billed. This carrier stated that we should only receive full reimbursement for the first and 1/2 for the remainder.

    Does anyone know what is correct?

    Thanks

  7. #7

    Default

    I work for a General Surgeon who specializes in thyroid. She does this often. I code the 10022 and the second 10022 with a 59. She always marks x2 by the 76942 but I only bill it once. Same for the 76536. I only bill it once. I have no problems getting it paid this way.

  8. #8

    Smile Reinbursement for billing of multiple thyroid nodule biopsies

    Hi Jennifer...

    Thanks for your response...my question now is the Endocrinologist I work for
    performs a biopsy on multiple nodules...she may biopsy anywhere from 1 to 10depending on the size of the nodules I bill the 10022 using Mdifiers 76 & 59 also lt or rt (which is what the American Assc of Endocrinologist advised)

    I have been receiving full reinbursement from all carriers for the multiple biopsies including Medicare, Recently one of the local HMO's are reimbursing in full for the first and 1/2 for the remainder. My argument is that even though this is a surgical procedure it is not a multiple procedure but a repeat procedure..The Dr is taking the same risk with every aspiration

    Am I correct on this? Please advise if you have any experience in regards to reinbursement for the additional units

    Thanks in advance for any information you may have

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