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0159T w/ 19287

Kelly Posted Fri 16th of October, 2015 16:18:28 PM

When doing an MRI breast localization (19287) can CAD (0159T) also be billed if properly documented

SuperCoder Answered Mon 19th of October, 2015 06:56:30 AM

Yes, we can bill 0159 with 19287, as there is no bundling in the codes. So in case of proper documentation CAD and MRI breast localization will be billed separately.

Thankyou

Kelly Posted Mon 19th of October, 2015 10:07:35 AM

I forwarded your above response and received the following back what are your thoughts to this response:

Kelly,

I appreciate your diligence with this, but we CANNOT bill that code (0159T) because it can only be billed with 77058 and 77059. It is an add-on code. If they used CAD as part of the localization, then it is included with the MRI localization and not allowed to be billed separately. It is not going to bundle because you can't bill this code with any other codes except 77058 and 77059. I have had to void this charge because it is a huge compliance issue with the payer. I think your compliance department needs to look beyond CCI edits and read when it is appropriate to code 0159T. In this case it was not appropriate.

SuperCoder Answered Tue 20th of October, 2015 07:12:39 AM

That's a miss on our part. Thank you for the suggestion.
We researched and checked with publications as well, code 0159T can only be billed with CPT 77058 and 77059.
If CAD performed with MRI guidance for localization, then it would be considered included in the primary procedure.

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