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Please help with billing for ultrasounds….

  1. #1
    Default Please help with billing for ultrasounds….
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    If both a complete (76700) and a limited ultrasound (76705)for the same dx of abd pain are performed and documented, would it be appropriate to bill both (same date of service same session)? A mod 59 can be appended to the secondary to bypass edit, but I believe a complete ultrasound alone is sufficient since it is the same dx.
    Any insight is much appreciated

  2. Default
    I think your other option besides mod 59 would be a mod 76 or 77 with this. Depending on what our doctors do, really determines for me if I bill it with a mod or not. More often than not, we do bill it with a mod instead of not billing at all. Right or wrong, it is what our doctors want.
    Hope that helps.

  3. #3
    There was really no reason to repeat the ultrasound in this case, or at least nothing was documented???

  4. Default Ultrasound help
    If you check your National CCI edits then you should be able to bill for both IF the documentation supports it. You would most likely want to append it with a -59.

  5. Default
    You don't say if you're doing this in the hospital or in am imaging center. You don't state why one is a complete abd u/s and the other is limited but I suspect your docs are zeroing in on something in particular on the limited study and think it's a separate procedure. However, you state this was done at the same time so I don't see how a separate procedure could be billed. Modifier 59 states separate and distinct. Per your post, it wasn't separate.

    Diane Huston, CPC,RCC

  6. #6
    Check the Medically Unlikely (MU) edits. CCI Chapter billing guidelines specifically state it is highly unusual that "family codes" would be reported at the same setting, instead the most comprehensive code should be billed.

    Julie, CPC

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