Results 1 to 9 of 9

ultrasound w/ biopsy

  1. Question ultrasound w/ biopsy
    Medical Coding Books
    codes the dr used are 76872, 55700, and 76942 with a dx of elevated psa...the ultrasound and imaging were denied....any suggestions?
    thank you

  2. #2
    Did you bill it as 55700, 76872, 76942-59? What's the denial reason?

  3. #3
    I typically bill 55700, 76942 -26 because that's ultrasound guidance for needle placement it doesn't stipulate the approach. So if the doc did a needle biospy of the prostate and used ultrasound guidance, 76942 would be correct even if it's transrectal. 76872 is just a transrectal ultrasound, but the description doesn't stipulate that it is used to identify the site of needle entry during a biopsy (like it does for 76942), not to mention, if you look at 55700 it tells you to use 76942 for imaging guidance. No payer is going to pay for both, so I'd just use 76942, that's just what I think anyway.

  4. #4
    I bill all three and they get paid. I bill them in the order that I typed on the previous email.

  5. #5
    The American Urological Association has a letter you can print out and attach as part of your appeal to the insurance company in question. It's directed to the Medical Director and has a very thorough explanation of why each of these three codes is billable and payable. Some insurances have their own guidelines. For example, we have a couple where they won't pay on 76872 unless we use modifier -59. But you should definitely appeal your denial.

    Zaida V. Aquino, CPC

  6. Default
    thank you...everyone for your help

  7. Default
    do you know where on their website this is found?
    thank you

  8. #8
    I bill all three and they get paid and I don't use a modifier.

  9. #9
    In reply to your question about where to locate the letter on, go to Practice Resources and then to Appeal Letters. Next choose the letter that says Transrectal Ultrasound Prostate Biopsy. I hope you win your appeals Sorry for the late reply.

    Zaida V Aquino, CPC

Similar Threads

  1. Prostate biopsy/Transrectal Ultrasound denial
    By almag69 in forum Urology
    Replies: 2
    Last Post: 11-01-2015, 10:01 AM
  2. MRI-ultrasound fusion prostate biopsy
    By vanessa01 in forum Urology
    Replies: 3
    Last Post: 08-03-2015, 07:06 AM
  3. Needle Core Biopsy with ultrasound guidence
    By Bwray in forum General Surgery
    Replies: 1
    Last Post: 02-23-2011, 03:13 PM
  4. Transrectal Ultrasound & Prostate Biopsy
    By Partha in forum Urology
    Replies: 0
    Last Post: 10-05-2009, 10:12 AM
  5. Ultrasound Guided Core Biopsy
    By Trendale in forum General Surgery
    Replies: 4
    Last Post: 04-14-2008, 11:57 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.