Results 1 to 4 of 4

76376 and Necessities

  1. #1
    Default 76376 and Necessities
    Exam Training Packages
    Hello everyone! Long time listener, first time poster. *ducks for the lame joke*

    Here's the thing. I work with a group of physicians. A part of their Prostate Biopsy protocols use the code 76376 or 3D rendering. The problem I'm running into is that the 3D rendering is being denied for not medically necessary.

    Is there a link with a letter which states the necessity of the 3D rendering or links I can use to draft a letter?

    Thanks!

  2. #2
    Location
    Alexandria, LA
    Posts
    518
    Default
    With a medical necessity denial it sounds like the payer has a local policy. Some Medicare contractors require 2 diagnoses with 76376 or 76377 - one giving the patient's disease or symptom, and a 2nd from 793.x to indicate that the base scan wasn't sufficient.
    Have you checked for an LCD or policy on other payer's sites?

  3. #3
    Default
    Quote Originally Posted by donnajrichmond View Post
    With a medical necessity denial it sounds like the payer has a local policy. Some Medicare contractors require 2 diagnoses with 76376 or 76377 - one giving the patient's disease or symptom, and a 2nd from 793.x to indicate that the base scan wasn't sufficient.
    Have you checked for an LCD or policy on other payer's sites?
    We're doing so now. A part of our problem deals with one payor which bundles this payment in with other codes related to a biopsy.

  4. #4
    Default
    Apologies for the bump but is there any other resources we can use to draft a letter approving this? Medicare does pay for the 76376 per LCD's but we need information to convince payors to cease bundling the payment.

Similar Threads

  1. 3d - 76376
    By nbohm in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-19-2013, 12:00 PM
  2. 76376 and 76377
    By peeya in forum Cardiology
    Replies: 3
    Last Post: 04-26-2012, 01:59 PM
  3. Radiology - 76376
    By nbohm in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-29-2012, 04:45 PM
  4. CT 3D reconstruction (76376)
    By dmjohnson13 in forum Modifiers
    Replies: 0
    Last Post: 08-10-2011, 02:55 PM
  5. 76376
    By tracross in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-26-2007, 07:30 PM

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?

Login

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.