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Medicaid Denial

James Posted Mon 28th of July, 2014 10:19:30 AM

I have coded and billed NC Medicaid
37227
36247 -59
75710 -59
75625
36248
76937
All line items were paid except 76937.
They said 76937 was not billed with primary code. CPT just says not to report 76937 in conjunction with a few other codes none of which I billed. What are the primary codes I can't bill with this add on code?

Thank you

SuperCoder Answered Mon 28th of July, 2014 11:11:07 AM

76937; Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)
Notes:
(Do not report 76937 in conjunction with 37191, 37192, 37193, 37760, 37761, 76942)

(If extremity venous non-invasive vascular diagnostic study is performed separate from venous access guidance, use 93965, 93970 or 93971)
Add On Code Notes:
Primary code(s) that can be billed with this Add-On code is at Contractor’s discretion.

I was unable to find on NCDHHS or Nc Tracks any information on the code but I was able to find a transmittal from CMS regarding this code. See page 10 of 12 in the following transmittal.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2636CP.pdf

The only other suggestion I have is to call NC Medicaid regarding the denial and request that they point you to something in writing that states the primary codes that are to be used with this code.

Thanks for your question and I hope this helps you.

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