Radiology Coding Alert
Consider MUEs, CPT® Guidelines for Laterality Modifier Denials
Question: Why might I be receiving a denial for frequency when submitting two units of a 19083 with modifiers LT and RT to Medicare? Tennessee Subscriber Answer: The bilateral surgery indicator of “1” indicates you can bill 19083 (Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance) as a bilateral procedure. However, if you refer back to question “Look to CPT® Rules When Handling 19083, +19084 Denials,” you’ll see that the CPT® book instructs you to report one unit of 19083 for bilateral services. You will report one or more units of +19084 (…each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) for the contralateral breast and all additional lesions. Furthermore, you can see that 19083 has a MUE of 1, which means that only one unit of 19083 may be submitted to the payer on a given date of service (DOS). A submission of 19083 on separate lines with modifiers LT (Left Side) and RT (Right Side) will result in a flag in the Medicare system for invalid CPT® code frequency. In some instances, you may override denials such as this by submitting the code with modifier 50 (Bilateral Procedure), instead. However, as the CPT® guidelines state, that would be incorrect in this example.
Radiology Coding Alert
- ICD-10-CM 2021:
Get Your First Look at Incoming Changes to ICD-10-CM 2021
Don’t overlook pertinent details that don’t involve new, revised, or deleted codes. With the huge [...] - Look Beyond the New ICD-10-CM Coding Changes
If you want to get the most out of the ICD-10-CM updates, you’ve got to [...] - Reimbursement:
Maximize Your Shot at Reimbursement Success on Modifier 22 Claims
Rely on some key modifier info and expert guidance to limit appeals and boost your [...] - Documentation:
Query Your Providers With Increased Ease Using These Tips
Learn how to set up an efficient, working system of communication. The radiology specialty presents [...] - You Be the Coder:
Look to CPT® Rules When Handling 19083, +19084 Denials
Question: Our radiologist performed a bilateral percutaneous breast biopsy with placement of a clip. Three [...] - Reader Questions:
Don't Code Separately for Multiple Imaging Modalities with 50432
Question: A patient presents to the emergency department (ED) with dysuria and renal colic. The [...] - Reader Questions:
Use ACR Guidance for 76801 Amniotic Fluid Reporting
Question: What are the rules surrounding documentation of amniotic fluid on an initial maternal fetal evaluation [...] - Reader Questions:
Consider MUEs, CPT® Guidelines for Laterality Modifier Denials
Question: Why might I be receiving a denial for frequency when submitting two units of [...]
