Jennifer Posted Wed 27th of July, 2016 11:26:00 AM
Now our office is receiving denials from Medicare carriers when using 76942 and 76872 when performing prostate biopsies. I thought this was resolved in the past, but now it is rearing it's ugly head again. Bottom line- which modifier would be appropriate under the circumstances for 76942?
SuperCoder Answered Thu 28th of July, 2016 04:40:57 AM
The correct answer depends upon the reason for denial. Payers have different limitations on ultrasound codes being used together.
Some pay for both ultrasounds on the same day if 76872 is clearly diagnostic, while others only cover the needle guidance (76942).
Using a different diagnosis code for the transrectal ultrasound than the codes used for the biopsies may also help obtain full reimbursement. If they have denied because of the bundling of code 76872 with
76942, you may append modifier 59 to code 76872 and provide a different diagnosis. Hope this helps!! Thanks!!