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Pediatric Pulmonology

Randi Posted Mon 25th of June, 2012 18:46:36 PM

What is the appropriate way to bill for 94728 with 2 units? A pre and a post Spirometry test is performed to see how the patient responds to Albuterol. We get paid for 1 unit but are having difficulties getting both units paid. We are using modifier 76. We also send medical records when requested and it still gets denied.

SuperCoder Answered Wed 27th of June, 2012 22:05:06 PM

We are working on this. Please be patient. Thanks

SuperCoder Answered Thu 28th of June, 2012 21:30:51 PM

Laboratory procedure codes 94726, 94727, 94728, and 94729 may be reimbursed as follows:
• The total laboratory component may be reimbursed to NP, CNS, PA, physician, portable X-ray supplier, radiological laboratory, and physiological laboratory providers for services rendered in the office setting; and to hospital providers for services rendered in the outpatient hospital setting.
• The professional interpretation component may be reimbursed to NP, CNS, PA, and physician providers, may be reimbursed for services rendered in the office setting; and to physician providers for services rendered in the outpatient hospital or inpatient hospital setting.
• The technical component may be reimbursed to NP, CNS, PA, physician, radiation treatment center, portable X-ray supplier, radiological laboratory, and physiological laboratory providers for services rendered in the office setting; and to radiation treatment center providers for services rendered in the outpatient hospital setting.

We could not find enough guidance on this but as stated Modifier 76 is allowed with 94728. I suggest you asking for details for the reimbursements with the carrier and appeal them for that exta unit.

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