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please help-We have a Medicare

  1. #1
    Location
    San Antonio
    Posts
    64
    Default please help-We have a Medicare
    Exam Training Packages
    We have a Medicare patient who the Doctor wants to charge a 20610 twice with mod 76 because he is asperating and injecting in the same sight is this possible to bill code twice mod 76 was the only one we could come up with. It states in the cpt book asperation and or injection so I did not think could bill code twice but he is doing both. please advise
    thank you
    Tracey Stanko CPC

  2. Default Injection in same joint
    Many Medicare carriers do not allow for reimbursement when the same joint is injected twice. There is no Medically Unnecessary Edit (MUE) on this code and no guidance from the Georgia Medicare Carrier so I would suggest you contact them and ask for their guidance.

  3. #3
    Location
    San Antonio
    Posts
    64
    Default
    The same Joint is not being injected hes asperating first then injecting same sight. Is that what you are referring to I am in Texas
    thank you
    Tracey Stanko CPC

  4. Default
    But the same code is used for both aspirations and injections. They won't pay for both.

    ~L
    CPC, CGSC, COSC

  5. #5
    Location
    San Antonio
    Posts
    64
    Default
    not even with a modifier 76?

  6. #6
    Location
    Columbia, MO
    Posts
    12,570
    Default
    You cannot use the 76 because it is not the exact same procedure being repeated in a different setting. One is aspiration and one is injection and both are performed in the same session. There are several CPT assistants on this and one of them covers this scenario and states you can only bill for one.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    San Antonio
    Posts
    64
    Default
    Quote Originally Posted by mitchellde View Post
    You cannot use the 76 because it is not the exact same procedure being repeated in a different setting. One is aspiration and one is injection and both are performed in the same session. There are several CPT assistants on this and one of them covers this scenario and states you can only bill for one.
    Can you please give me that assistant and scenario if you would not mind I am trying to explain this to a Doctor
    thank you very much for your assistance you have been very helpful I think it will help if I have something to show

  8. #8
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Try CPT Assistant, March 2001.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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