Could someone update me on the medicare rules for billing cpt codes 76700 and 76770? I was advised by a radiologist that mcare no longer will accept 76770 and 76700 together with modifier 59 on the second one..that only should bill 76700 since that is considered complete abdomen sono. He also mentioned Medicare multiple procedure payment reduction rule..this seems to reduce amount paid on TC modifier services PE(practice expense) part..then i read something that said this doesn't apply to group practices? Anyone know if it is not reccomended to bill those two together anymore? are they now considered bundled? Thanks for your help.
There are no CCI edits for 76700 and 76770, but it would be unlikely that both would be coded together, especially at one session. There is a lot of overlap in these codes, so if you have a complete abdomen, you would have to double image kidneys, aorta, IVC to get 76770 at the same session. And that wouldn't be good.
If separately ordered (different sessions), medically necessary, and performed at different sessions (again for medically necessary reasons) you could code both.
The MPPR reduces the Medicare payment for the TC (non-hospital), and PC when 2 or more ultrasounds, CT/CTA, MRI/MRA are done or interpreted at the same session.
It applies to individual doctors in a group practice. If Dr. Jones and Dr. Smith both work for ABC Radiology and the practice bills under a group #, then if Dr. J read a CT abdomen for patient Miller and Dr. S read an abdominal ultrasound for the same patient, currently both will be paid at full fee schedule. CMS originally planned this year to apply the reduction to all doctors in the group, and that's in the proposed rule for next year. They say they've figured out how to do it. So, if that becomes final, next year, even if different doctors read as in the example above, one will be reduced.