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Code Inquiry

Oscar Posted Thu 23rd of August, 2018 10:49:21 AM
Hello, I am looking for what CPT codes we would use to bill an Ultrasound and CT Scan of the abdomen and pelvis for when being done in an ambulatory surgical center and also when its done in an office setting (POS 11). Thank you!
SuperCoder Answered Fri 24th of August, 2018 06:00:52 AM

Hi Oscar,

Thank you for your question.

These are the billable CPT code for Ultrasound abdomen: 76700 & 76705, Ultrasound pelvis: 76856 & 76857, CT Scan Abdomen: 74150, 74160 & 74170, CT scan Pelvis 72192, 72193 & 72194, CT scan Abdomen with Pelvis: 74176, 74177 &  74178. These codes are billable for ASC setting as well as Office setting. But for Office setting billing of CT scan require special coverage.

As per CMS some contractors on the basis of bill type may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. The following  place of service for bill types Hospital Inpatient (Medicare Part B only), Hospital Outpatient, Hospital - Laboratory Services Provided to Non-patients, Skilled Nursing - Inpatient (Including Medicare Part A), Skilled Nursing - Inpatient (Medicare Part B only) and Skilled Nursing – Outpatient and Critical Access Hospital are appropriate for these radiological services. Please check your coverage before billing CT scan in office setting as some contractors doesn’t provide coverage for these CPT codes in office setting.

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53252

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33284

 

Hope this helps!

Oscar Posted Fri 24th of August, 2018 06:17:14 AM
This was a HUGE help.....!!! If our MAC is NGS with locality 15/16, would the CT scans mentioned above be covered? Thank you kindly!
SuperCoder Answered Fri 24th of August, 2018 07:12:35 AM

Hi Oscar,

Thank you for the question.

The locality mentioned in query as 15/16 refer to Illinois or any other region. Kindly brief us.

 

 

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