Wiki CODING 60500 WITH 78800 OR 78070?

[Sgladd5]

WHAT WOULD BE THE BEST WAY TO CODE A HIGH-RESOLUTION SESTAMIBI SCAN, FOLLOWED BY INTRAOPERATIVE NUCLEAR MAPPING AND THEN A PARATHYROIDECTOMY? CURRENTLY WE ARE CODING USING 60500, 78800-26, AND A SEPARATE U/S WITH 76536-26, BUT WE ARE CONSTANTLY GETTING DENIALS FROM THE INSURANCES FOR THE 78800 CODE. I WAS DOING SOME RESEARCH AND FOUND THE 78070 CODE BETTER DESCRIBES WHAT IS BEING DONE, BUT IT CANNOT BE CODED WITH 60500. DOES ANYONE KNOW WHY THIS CANT BE BILLED TOGETHER, OR HAVE A SUGGESTION ON HOW TO CODE THIS BETTER? THANK YOU!!

 

[sls314]

60500 and 78070 have an NCCI edit. 78070 is considered a component of 60500, and a modifier is not allowed to override the relationship. That is why those codes cannot be billed together.

I am not familiar with that type of scan, so I cannot offer suggestions on how to code it accurately.

I will caution you based on the code examples you gave in your OP: You stated that the 78070 code better describes what is being done over the 78800/76536. If that's correct, you can't bill the 78800 and 76536 just because 78070 has an NCCI edit.

I hope someone else will be able to chime in and advise further on whether 78070 is the correct code, or whether there's a different code you haven't considered.