Inclusive procedure 76705 in Radiology Coding and Billing Forum

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Inclusive procedure 76705

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uryogesh	Inclusive procedure 76705	Lead	[-]
Posts: 41 Jun 25 07 9:40 AM Reply Quote More My Recent Posts	Tags : None Anyone can help me out in this issue. While billing to Oxford insurance for cpts 76705 and 93976, we got payment for 93976 and 76705 denied as inclusive even though when billed with 59 modifier. Is there any policy like this cpt will not be considered when billed with 93976. Yo
SMVerno	Re: Inclusive procedure 76705	#1	[-]
Posts: 140 Jun 25 07 10:45 AM Reply Quote More My Recent Posts	Each insurance company has their own policies and procedures for coding and there isn't a modifier on earth that will change anything. If your doctor is contracted and he agreed with the coding policies, then you write it off. If your doctor is not contracted, you bill the patient. One last thing,,,, using modifier 59 or any other modifier never guarantees payment. All it does is get you past the insurance company's software edits.
NaGahl	Re: Inclusive procedure 76705	#2	[-]
Posts: 1724 Jun 25 07 5:04 PM Reply Quote More My Recent Posts	Many insurance companies will not automatically pay a claim with a 59. Because it's a thoroughly over used and abused modifier you will likely have to submit documentation to show why the service should be paid separately.
BenchodNumber1	Re: Inclusive procedure 76705	#3	[-]
Posts: 48 Nov 6 07 4:42 PM Reply Quote More My Recent Posts	they are mutually exclusive... you can use modifier 25
Doo	Re: Inclusive procedure 76705	#4	[-]
Posts: 6226 Nov 6 07 6:07 PM Reply Quote More My Recent Posts	Only if you have a reason to use a modifier. You can't just slap one on to get it paid. The Office of Inspector General (OIG) published a study in November 2005 detailing significant incorrect use of modifiers 25 (modifiers used when an E&M or other procedure or service, is billed in conjunction with another procedure). The OIG found that thirty-five percent of claims using modifier 25 allowed by Medicare in 2002 did not meet program requirements, resulting in $538 million in improper payments. Problems ranged from definite inappropriate usage, to insufficient documentation to determine if the use was appropriate, to needless use (e.g., an E&M with a modifier 25 in the absence of another procedure). CMS has accepted the OIG findings and will be urging carriers to heighten scrutiny of these modifiers. This study followed a California study performed in 2003 of a probe of 200 randomly-selected claims. Sharon
Steve Verno	Re: Inclusive procedure 76705	#5	[-]
Posts: 10211 Nov 7 07 4:39 AM Registered User Reply Quote More My Recent Posts	Modifier 25 is only used with an E/M. it is never used with a radiology code.
BenchodNumber1	Yea	#6	[-]
Posts: 48 Nov 15 07 10:43 PM Reply Quote More My Recent Posts	Yea, well, you have to tell the doc, of course you can't just slap a 25 on every as you please. Thanks Ben
Steve Verno	Re: Inclusive procedure 76705	#7	[-]
Posts: 10211 Nov 15 07 11:32 PM Registered User Reply Quote More My Recent Posts	Ben Please help us out. Why did you suggest using modifier 25 with CPT 93976 Duplex Scan of Arterial Inflow and Venous Outflow and 76705 Abdominal ultrasonography ?
aleaver	Re: Inclusive procedure 76705	#8	[-]
Posts: 1081 Nov 16 07 8:48 AM Reply Quote More My Recent Posts	Obviously the 25 is incorrect. There is a reason this 76705 is inclusive. When performing Duplex scan, you see all of the retroperitoneal organs. Normally, there shouldn't be a need to perform an ultrasound as well. April

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