Fiducial coding

I am having trouble getting Medicare to pay for all of my fiducial tumor markers of the prostate. Here's what I'm coding:
55875
76873 - 59
76965

Medicare pays for 55875 and 76965. They seem to bundle the 76873 with 76965 however they are different. One is for volume of the prostate and one is used for US guidance.

Any tips, help, anything?

Thanks,
Amy

re: Fiducial coding

The code 76873 is for the evaluation for prostate volume if you are planning brachytherapy treatment. 76965 is for ultrasound guidance for guiding the implants during the course of brachytherapy. you cannot code for the diagnostic(76873) if you are performing the acutal procedure as the diagnostic guidance is built into the code for the therapy. You are double billing!!

re: Fiducial coding

I haven't really looked at the code descriptions. I came into the office and it has "always been done this way" is what I was told. Now I'm changing things up and things are getting rejecting. I see what you are talking about with the double billing. Thanks for bringing that up. I'll have to adjust that and maybe they will start getting paid. :)

re: Fiducial coding

the golden rule of coding w/ragiology is that you cannot bill for a diagnostic US if U are perfoming a procedual US, it is always included in the procedure. A good book to have that helps explain and gives a better definition of all the CPT® codes is called Coders Desk Reference to Procedures. Good example would be a patient coming in for a diagnostic colonoscopy, if the provider only looks at the colon and nothing else was done you would bill for the diagnostic part, but if the provider performed any kind of procedure during the colonoscopy(removal of polyps) you would bill only for the procedural colonoscopy. Hope that helps explain it a little bit better. I completely understand the "its always been done this way" does not mean it is correct, and an FYI, they will pay for the diagnostic before they will pay for the procedure as it is a cheaper reimbursement, you might wanna explain that to them also. their cutting off their nose to spite their face and it will trigger audits also, good luck and if i can be of any more help, please ask:)