We were told that there is a new code that can be used for fibroscans. We are currently using 91200 liver elastography, the code we can now use is 76981 ultrasound elastography, parenchyma. Is anyone else (in gastroenterology) using the 76981 and getting paid for this?
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Wiki FIBROSCAN
- Thread starter dfanel
- Start date
bbeatty
Networker
I am currently trying to find out the same information. My providers want to bill the 76981 but I am concerned that we are over reaching. Of course the company that makes the fibroscan machine is telling them that they can bill 76981.
natcat74
New
I am on here looking for the same answer. Our providers are trying to bill in addition to 91200 and all I am seeing are denials. I don't believe they can bill both, they are being told to bill the 91200 with a 26 and the 76981. The higher reimbursement is what they are trying to get, yet all I am getting are denials.
jlara001
Contributor
we are billing the 76981 and seeing payment, however not all insurance plans accept this code. Some Medicaid plans want a prior authorization on the 76981 or simply want the 91200.
Lorisp830
New
We just started billing 76981 for our Fibro scans. Blue Cross is one of our largest payers we accept and we are having a very hard time receiving payment for these tests. We are still trying to figure out exactly what Blue Cross accepts for this. Too bad there isn't more information online regarding billing.
wi6003la
New
Is it the dx code BCBS is denying? Our company is also being approached regarding billing CPT code 76981. BCBS of MS has a policy for 76981 and it lists dx codes that are covered.
cedwards
Guru
Hi All!
Just wanted to follow up on this thread. I am just getting back into GI. In my previous practice we billed 91200 for Fibroscans. I am now seeing the 76981 should be used, but I have some concerns about using the 76981. That is for imaging elastography. How does the Fibroscan constitute as imaging? We are not performing ultrasounds.
Does anyone have any current literature to support the 76981 without actually performing imaging (ultrasound)? Everything I have found is old and shows to use the 91200.
Code 91200 represents nonimaging liver elastography. This includes mechanical shear wave liver elastography—also known as transient elastography—as well as acoustic radiation force impulse liver elastography—see CPT Assistant, October 2017. An example of 91200 is the FibroScan, which produces a numeric value, not an image. Note that code 91200 is restricted to exams of the liver.
Just wanted to follow up on this thread. I am just getting back into GI. In my previous practice we billed 91200 for Fibroscans. I am now seeing the 76981 should be used, but I have some concerns about using the 76981. That is for imaging elastography. How does the Fibroscan constitute as imaging? We are not performing ultrasounds.
Does anyone have any current literature to support the 76981 without actually performing imaging (ultrasound)? Everything I have found is old and shows to use the 91200.
Code 91200 represents nonimaging liver elastography. This includes mechanical shear wave liver elastography—also known as transient elastography—as well as acoustic radiation force impulse liver elastography—see CPT Assistant, October 2017. An example of 91200 is the FibroScan, which produces a numeric value, not an image. Note that code 91200 is restricted to exams of the liver.
Mlt7935
New
My company is also seeing BCBS denials on fibroscans if anyone can find the DX that they are accepting it would be great if you could share
CXZook
Networker
What CPT are you using for Fibroscans? The scan does save an image of the liver that the provider uses to interpret and that image is scanned to our medical record. What we are going back and forth on is that scan considered an US scan?
Hi everyone! We use to use 91200 and a few months ago the rep told us to use 76981. Most insurances have been paying with no issues, Blue Care Network requires authorization so we can usually get a retro auth for that. But now Priority Health Medicaid is denying stating "Verify codes are properly billed including a modifier when required. Not a contracted service- do not bill member" Anyone have suggestions? we own the fibro machine so we don't use modifiers on them
PatasaurusR
Contributor
We use both - 91200 for Fibroscans (scanned by a medical assistant) and 76981 if done by the Ultrasound tech. Two different exams. I don't see why you would need a modifier for the Fibroscan if you own the machine. The GI doctors (not a radiologist) can interpret the numbers/images from that machine.