Wiki Can CPT 10005 and 76536 be billed on same DOS in POS 11?

[MatthewSchweyer]

Can CPT 10005 and 76536 be billed on same DOS in POS 11? I am getting conflicting information. When reviewing the CCI edits, they do not preclude it. Please help. matt

 

[SharL]

Can CPT 10005 and 76536 be billed on same DOS in POS 11? I am getting conflicting information. When reviewing the CCI edits, they do not preclude it. Please help. matt

We have been reviewing this as well. There are no CCI edits on 10005 and diagnostic U/S 76536, since the 10005 includes the imaging component, and one is not assigning the guidance (76942) separately. It is the guidance code that is included into the diagnostic. It is confusing, however. By not seeing edits, one would assume it can / should be coded to Medicare together with appropriate documentation (separate reports identifying the findings). Other payors (except Medicaid) typically will pay with reports. Typically, we have patients who have the diagnostic on a separate day and then that study determines scheduling of the FNA (hospital setting). Does anyone have more specific guidelines?