Wiki CPT 76498 & CPT 72197

[klpawson]

Does anyone know if Medicare and/or Medicare products consider 76498- unlisted MRI bundled with 72197? If so, do you know where I could find documentation to show this? Thanks!

 

[iowagirl77]

I believe it would depend on what the unlisted procedure was. Was it in the same area as 72197, or completely separate area? Was a clear description of the unlisted procedure noted on the claim? If the description is noted on the claim, I would appeal with documentation if you've determined that it is correctly coded as a separate but unlisted procedure.

 

[klpawson]

I believe it would depend on what the unlisted procedure was. Was it in the same area as 72197, or completely separate area? Was a clear description of the unlisted procedure noted on the claim? If the description is noted on the claim, I would appeal with documentation if you've determined that it is correctly coded as a separate but unlisted procedure.

Thank you!