Author Topic: OB ultrasound  (Read 904 times)

ajack092

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OB ultrasound
« on: September 07, 2016, 07:24:24 AM »
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!!

Michele

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Re: OB ultrasound
« Reply #1 on: September 07, 2016, 07:41:59 AM »
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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ajack092

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Re: OB ultrasound
« Reply #2 on: September 07, 2016, 07:58:57 AM »
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!!

kristin

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Re: OB ultrasound
« Reply #3 on: September 08, 2016, 07:26:23 PM »
Could it be a maximum frequency issue with the payer for the DOS?

Michele

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Re: OB ultrasound
« Reply #4 on: September 09, 2016, 08:16:31 AM »
I thought that but the definition of 76812 states to bill additionally for each gestation. 
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Tameka79

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Re: OB ultrasound
« Reply #5 on: September 09, 2016, 09:02:13 AM »
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.