Wiki Codes for ultrasound in ortho dept

[lsauseda]

I'm sooo confused and I need help. Here is the dictation. If I could have your opinions on how to code this, I'd appreciate it.

"We used the real-time ultrasound to look at her right shoulder. We could appreciate that the long head of the biceps was in its normal location. We then used real time ultrasound to localize the needle in the subacromial space and injected 80 mg of Depo-Medrol."

Now the problems I'm finding are with the modifiers. The doctor that does this procedure owns his machine. He performs this procedure and reads the results in his office during clinic visits. Medicare hasn't been paying because they want a modifer 26. But if hes performing all aspects of this procedure, would we still use this modifier. And blue cross has been denying payment because of medical necessity. I need help in trying to figure this out. Thank you!

 

[JoyJoy]

Ultrasound guidance 76942

You didn't mention a code, I work in a Sports Medicine/Ortho dept and we bill the 76942 for US guidance for the majority of our injections, especially when using Synvisc. We have never used a modifier, especially the 26, and we also own our own equipment as well.

As Medicare does require medical necessity, but we not had any problems w/ getting paid.

If Medicare is requiring the use of a 26 modifier it may mean you are using the wrong code.
Hope this helps.

 

[lsauseda]

I've only been coding ortho for about 3 months. The girls that coded before me would use the following codes for this example.

20610 - RT
76942
76882
J1040

But now that these girls are gone, I'm getting the denials and I'm questioning whether these have been coded properly.

 

[JoyJoy]

you have the right codes, we don't use the 76882, my experience with medical necessity denials would be not using the right diagnosis, you should go on the websites from each insurance carrier and follow the medical policy guidelines for pain management. As far as the denial with the modifier 26, it may be a credentialing or facility issue with the provider.