Robin Posted Thu 01st of November, 2012 17:31:33 PM
I know that I have seen a list of Medicare Medical Necessity ICD-9 codes that can only be used for medicare patients so that the TV Pelvic US will get paid. I have lost that list and was wondering if you knew what these codes are or where I can go to get them?
SuperCoder Answered Fri 02nd of November, 2012 20:38:03 PM
There's a general list available under the Crosswalks on http://www.supercoder.com/cpt-codes/76830.
The list isn't specific to Medicare, and it doesn't guarantee reimbursement. I'm not seeing anything coming up when I search 76830 on the Medicare coverage database.
As a general note, the rule is to code based on the documentation - either confirmed diagnosis or signs/symptoms. Medical necessity for the TV US should be made clear in the documentation, especially if it's performed in addition to a TA US.