Question from Tennesee physician's office

Unknown
in Part B Archive
If possible, could someone offer some advice?
If a ultrasound of an extremity (limited) was done on the right and left arm, 76882, what modifiers could be used for billing? The ultrasound was done in the physician's office with their equipment?
Also what if it was done on three extremities (limited) example right and left arm and left leg, which modifiers?
This code 76882 has a bilateral surgery (50) of "0" explained below

PC/TC Indicator (26):
1 = Diagnostic Tests for Radiology Services
Multiple Procedures (51):
0 = No payment adjustment rules for multiple procedures apply
Bilateral Surgery (50):
0 = 150% payment adjustment for bilateral procedures does not appl

Bilateral Indicator 0
Bilateral surgery rules do not apply to codes with a status indicator 0. The bilateral indicator is inappropriate for reasons such as:
* Physiology; is not a bilateral body part.
* The codes description states it is an existing bilateral procedure.
* The procedure is not commonly performed as bilateral. (These services do not meet the bilateral criteria.)
These codes should not be billed with modifiers 50, LT or RT.
The 150 percent payment adjustment for bilateral procedures does not apply.

Thanks,
Melinda B. Webb, CCS
Ulrich Medical Concepts
mwebb@ulrichbilling.com

Comments

  • EricaErica
    edited May 2017
    76882 has an MUE of two, so if both left and right arms are done, you should submit 76882 x2 with no modifiers.

    If both arms and a leg, then I would bill 76882 x2, 76882-XS

  • Unknown
    edited May 2017
    Thanks, would it make a difference if it was billed to Medicare?

    76882 has an MUE of two, so if both left and right arms are done, you should submit 76882 x2 with no modifiers.

    If both arms and a leg, then I would bill 76882 x2, 76882-XS

  • EricaErica
    CMS is the one who publishes the MUEs so no it would not make a difference. That is exactly how I would bill to Medicare and all payors.

    :) Erica
  • Unknown
    Thank you, I appreciate the help.
    Melinda

    CMS is the one who publishes the MUEs so no it would not make a difference. That is exactly how I would bill to Medicare and all payors.

    :) Erica


    Melinda B. Webb, CCS
    Ulrich Medical Concepts
    mwebb@ulrichbilling.com
  • Unknown
    edited May 2017
    Would I need to put a modifier on any of the procedures? 76 repeat procedure or service by same physician or other qualified health care professional
    Thanks, Melinda


    Thank you, I appreciate the help.
    Melinda

    CMS is the one who publishes the MUEs so no it would not make a difference. That is exactly how I would bill to Medicare and all payors.

    :) Erica


    Thanks, would it make a difference if it was billed to Medicare?
    Melinda

    76882 has an MUE of two, so if both left and right arms are done, you should submit 76882 x2 with no modifiers.

    If both arms and a leg, then I would bill 76882 x2, 76882-XS
    If possible, could someone offer some advice?
    If a ultrasound of an extremity (limited) was done on the right and left arm, 76882, what modifiers could be used for billing? The ultrasound was done in the physician's office with their equipment?
    Also what if it was done on three extremities (limited) example right and left arm and left leg, which modifiers?
    This code 76882 has a bilateral surgery (50) of "0" explained below

    PC/TC Indicator (26):
    1 = Diagnostic Tests for Radiology Services
    Multiple Procedures (51):
    0 = No payment adjustment rules for multiple procedures apply
    Bilateral Surgery (50):
    0 = 150% payment adjustment for bilateral procedures does not appl

    Bilateral Indicator 0
    Bilateral surgery rules do not apply to codes with a status indicator 0. The bilateral indicator is inappropriate for reasons such as:
    * Physiology; is not a bilateral body part.
    * The codes description states it is an existing bilateral procedure.
    * The procedure is not commonly performed as bilateral. (These services do not meet the bilateral criteria.)
    These codes should not be billed with modifiers 50, LT or RT.
    The 150 percent payment adjustment for bilateral procedures does not apply.

    Melinda B. Webb, CCS
    Ulrich Medical Concepts
    mwebb@ulrichbilling.com
  • EricaErica
    edited May 2017
    No, it’s not a repeat procedure, it’s 3 distinct procedures on 3 different body parts. The first 2 are billed in units and the 3rd with an -XS modifier to say separate anatomic site.



  • Unknown
    edited May 2017
    Ok, now I see. Sorry for the confusion, I misunderstood when it was stated as 76882 x2 , I thought it meant it was for two different line items not units. Again thanks for the help.
    Melinda


    No, it's not a repeat procedure, it's 3 distinct procedures on 3 different body parts. The first 2 are billed in units and the 3rd with an -XS modifier to say separate anatomic site.




    Would I need to put a modifier on any of the procedures? 76 repeat procedure or service by same physician or other qualified health care professional Thanks, Melinda


    Thank you, I appreciate the help.
    Melinda

    CMS is the one who publishes the MUEs so no it would not make a difference. That is exactly how I would bill to Medicare and all payors.

    :) Erica


    Thanks, would it make a difference if it was billed to Medicare?
    Melinda

    76882 has an MUE of two, so if both left and right arms are done, you should submit 76882 x2 with no modifiers.

    If both arms and a leg, then I would bill 76882 x2, 76882-XS If possible, could someone offer some advice?
    If a ultrasound of an extremity (limited) was done on the right and left arm, 76882, what modifiers could be used for billing? The ultrasound was done in the physician's office with their equipment?
    Also what if it was done on three extremities (limited) example right and left arm and left leg, which modifiers?
    This code 76882 has a bilateral surgery (50) of "0" explained below

    PC/TC Indicator (26):
    1 = Diagnostic Tests for Radiology Services Multiple Procedures (51):
    0 = No payment adjustment rules for multiple procedures apply Bilateral Surgery (50):
    0 = 150% payment adjustment for bilateral procedures does not appl

    Bilateral Indicator 0
    Bilateral surgery rules do not apply to codes with a status indicator 0. The bilateral indicator is inappropriate for reasons such as:
    * Physiology; is not a bilateral body part.
    * The codes description states it is an existing bilateral procedure.
    * The procedure is not commonly performed as bilateral. (These services do not meet the bilateral criteria.)
    These codes should not be billed with modifiers 50, LT or RT.
    The 150 percent payment adjustment for bilateral procedures does not apply.

    Melinda B. Webb, CCS
    Ulrich Medical Concepts
    mwebb@ulrichbilling.com
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