# Biopsy denials



## kwiegscpc (Mar 22, 2011)

Is anyone else having trouble with the 55700(Prostate needle biopsy), 76942(Us guidance needle biopsy) and the 76872(echo prostate transrectal). We are getting denials on the 76872, even with modifier. Any suggestions?


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## Kelly_Mayumi (Mar 23, 2011)

I have not seen or heard anything about the US being denied.  The AUA website has forms online to help with appeals.


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## zaidaaquino (Mar 24, 2011)

What modifier are you using and on what code are you appending it to?  Which insurance is denying?  Although all three codes are billable, some insurances have their own guidelines which require a modifier -59 on 76872.  Let me know.


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## valeriealbert (Mar 25, 2011)

kwiegscpc said:


> Is anyone else having trouble with the 55700(Prostate needle biopsy), 76942(Us guidance needle biopsy) and the 76872(echo prostate transrectal). We are getting denials on the 76872, even with modifier. Any suggestions?


We have expierienced this too.  We are appealing with the AUA letter of medical necessity and a copy of the CCI bundling edit showing they should not deny with 59 mod.


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## RobynS. (Mar 31, 2011)

55700
76942 26


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## RobynS. (Mar 31, 2011)

Sorry, didnt finish coding.......but it should be
55700
76942 26
76872 26 59


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## RobynS. (Mar 31, 2011)

MOD. 26 Depending on place of service


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