Wiki 76000 Confusion.

[nikkisgranny]

I am told that when docs use 76000 during surgery, i.e. removing hardware, we cannot bill for the professional component as this is a separate procedure. We have billed and have gotten paid for this.

Can someone explain this to me?

 

[Bella Cullen]

Where I used to work I would code 76000-5926 when done with another procedure in a hospital setting.
From what I was taught, you don't use the 26 modifier if you own the equipment. And since this was a surgery then it was probably the hospitals equipment so you would use 26 mod. And since that code is a separate procedure code you would use the 59 mod.
That is just how I did it.

 

[mbort]

76000 bundles with 20680 and should not be coded/billed seperately. The 59 modifier would not be justified as the doctor is using the c-arm/fluoro to either find the hardware or make sure that he removed everything.

The 76000-26 (for physician) can be codeable, however you need to pay very close attention to the NCCI Edits as it bundles with many procedures as well.

You were very lucky if you received payment for 20680 w/76000. The monies were not payable and it would not surprise me that some payors may eventually request a refund.

hope you find this helpful
Mary, CPC, COSC