Medical Billing Forum
Coding => Coding => : ajack092 September 07, 2016, 10:24:24 AM
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I have a claim denying for improper procedure code on a triplet ultrasound. CPT 76817, CPT 76811, CPT 76812, and CPT 76812-59. All paid except for the last CPT 76812-59. What is wrong with this code?? Suggestions?? Thanks!!
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Wow, triplets! I'm not a certified coder but there really is not enough information to help. Is that the only denial information? Did you verify the ICD10 is correct for triplets? If so I would call the insurance carrier to ask for further explanation.
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LOL!! Ikr??!! Yes that is the only denial reason. I did check the dx codes and I am a certified coder and I am stumped!! It honestly seems correct to me but it obviously is not. Guess I'll call the payer. Thank you!! Have a great day!!
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Could it be a maximum frequency issue with the payer for the DOS?
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I thought that but the definition of 76812 states to bill additionally for each gestation.
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I have a claim denying for improper procedure code on a triplet ultrasound. CPT 76817, CPT 76811, CPT 76812, and CPT 76812-59. All paid except for the last CPT 76812-59. What is wrong with this code?? Suggestions?? Thanks!!
Maybe you could remove the -59 because since it's an add on code I don't think it needs it. Also to make sure that the dx for that line specifies that it is for the third fetus. I would assume that the dx for 76811 was for the first fetus and the dx for the other 76812 was for the second fetus.