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Biopsy denials

  1. #1
    Location
    Madison, WI
    Posts
    19
    Default Biopsy denials
    Exam Training Packages
    Is anyone else having trouble with the 55700(Prostate needle biopsy), 76942(Us guidance needle biopsy) and the 76872(echo prostate transrectal). We are getting denials on the 76872, even with modifier. Any suggestions?

  2. Default
    I have not seen or heard anything about the US being denied. The AUA website has forms online to help with appeals.

  3. #3
    Default
    What modifier are you using and on what code are you appending it to? Which insurance is denying? Although all three codes are billable, some insurances have their own guidelines which require a modifier -59 on 76872. Let me know.

  4. #4
    Default
    Quote Originally Posted by kwiegscpc View Post
    Is anyone else having trouble with the 55700(Prostate needle biopsy), 76942(Us guidance needle biopsy) and the 76872(echo prostate transrectal). We are getting denials on the 76872, even with modifier. Any suggestions?
    We have expierienced this too. We are appealing with the AUA letter of medical necessity and a copy of the CCI bundling edit showing they should not deny with 59 mod.

  5. #5
    Location
    East Orange, NJ
    Posts
    6
    Default
    55700
    76942 26

  6. #6
    Location
    East Orange, NJ
    Posts
    6
    Default
    Sorry, didnt finish coding.......but it should be
    55700
    76942 26
    76872 26 59

  7. #7
    Location
    East Orange, NJ
    Posts
    6
    Default
    MOD. 26 Depending on place of service

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