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FNA with guidance

  1. Default FNA with guidance
    Medical Coding Books
    One of are Doctors bills
    76942
    10022
    76942,59
    10022,59
    The second group will sometimes deny as duplicate. Is he billing this appropriately? If not how should it be billed? He insists this is correct. Can someone please advise and provide me with a good source for the proper way to bill so i can let hiim read it. Thank YOu

  2. #2
    Location
    Jacksonville, FL
    Posts
    63
    Default
    Are they totally different sites? (I'm assuming d/t the "59", but want to double check) As long as the Dr isn't billing "per poke", I would think that 2nd set should be paying.

    Becki, CPC

  3. Default
    While it may be appropriate to report multiple FNA's (10022) for separate lesions/sites...

    The guidance should only be coded once....as per the CCI manual on the CMS website, the unit of service for codes 76942, 77002, 77003, 77012 & 77021 is per patient encounter, not the number of lesions, aspirations, biopsies, injections or localizations.

    http://www.cms.hhs.gov/NationalCorre....asp#TopOfPage

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

  4. #4
    Location
    Stuart Sailfish Chapter
    Posts
    867
    Default
    Great response Anthony!! and Great Link as well ! Kudos
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    AAPC Chapter Association Board of Directors ( Chair)
    Region 6, Wisconsin, Minnesota, Illinois, Indiana, Michigan, Ohio
    772-342-6976
    Candice.Fenildo@appcca.org

    "Nothing is stronger than the heart of a volunteer"

  5. Wink Billing Guidelines for 10022
    The Physician I work for also bills for biopsies:
    We bill the 10022 on one line w/Modifiers 76 & 59 ...We have been being paid by all carriers in full for all units billed . We bill the # of aspirations as units....
    Medicare will only pay 1 and then we appeal with documentation and
    they pay up to four in full, they stated that if there are more thasn 4 nodules we need to submit a letter of medical necessity..I have recently sent in some
    letters, however have not received a response as yet

    Does anyone know what is the correct way of billing the 10022 for multiple units?
    Should they be billed on seperate lines or on one line with appropriate modifiers?

    Any inforamtion anyone has would be greatly appeciated.

    Thanks

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