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Medicaid and 76817 with twins

  1. Default Medicaid and 76817 with twins
    Medical Coding Books
    Have patient with twins and physician did ultrasound on both fetuses. Normally we can submit 76817 with 59 modifier. Problem is Medicaid does not recognize 59 modifier so a 51 modifier was appended to the second code. Code correct states that we can't use a 51 modifier on 76817. When I checked in the CPT 2009 manual it does not show 76817 as 51 mod exempt. Any thoughts?

    Here is what we are trying to submit:
    76817
    76817-51

    Thanks for your help!
    Be Blessed!
    Zaida D. McGarry, CPC

  2. Default
    You did not mention whether this is a transvaginal or transabdominal u/s. If the physician did a transvaginal 76817 we only code it once, no matter how many fetuses are in the womb. If I'm wrong please correct me.

    GFontm CPC

  3. #3
    Location
    Kansas City, MO
    Posts
    751
    Default
    We bill using units when an add on code is not available. The diagnosis used must be the twin diagnosis. Since 76817 is for a transvaginal, then you only bill that once.

    If you have access to the CPT Assistant March 2003, it has excellent information regarding billing of OB ultrasounds.
    Last edited by amjordan; 02-27-2009 at 12:42 PM. Reason: Incorrect code used.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  4. Default
    My apologies it was CPT 76816: transabdominal. Where exactly can I get the CPT Assistant articles?
    Thank you for your help!
    Be Blessed!
    Zaida D. McGarry, CPC

  5. #5
    Location
    Kansas City, MO
    Posts
    751
    Default
    It is a periodical put out by the AMA. You can purchase an Archive CD with all of the past issues, which is what I use. They also have the past issues that you can purchase.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

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