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Second Posting - Prostate Biopsy U/S

  1. #1
    Default Second Posting - Prostate Biopsy U/S
    Medical Coding Books
    This has been discussed in the forum & backed by CPT Assistant when the transrectal US is a proper diagnostic one and distinctly different from the US guidance for prostate biopsy we can code 76872 in addition to 55700 & 76942, but what we are seeing is most payers deny 76872 as bundled?

    Any inputs will be greatly appreciated!

  2. #2
    Greeley, Colorado
    Many payors may need modifier -59 on 76872 to bypass their edits, if appropriate.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Thanks - but will it be ok to use mod 59 when there is no CCI edit?

  4. #4
    Greeley, Colorado
    I looked at the claim edits for a couple of the payors and they will accept -59. Keep in mind that commercial carriers don't alwasy follow CCI edits.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default Commercials...
    ...Agreed commercials have different edits and don't necessarily follow Medicare's CCI edits but how will we check/apply on our claims what commercials follow...?

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