Wiki Horizon BCBS denying CPT 76604 Ultrasound, chest and 76775 Ultrasound, retroperitoneal for Invalid Place of Service 21

[she803]

Good morning all!
I have a question regarding CPT 76604--Ultrasound, chest and 76775--Ultrasound, retroperitoneal denials from Horizon BCBS due to invalid place of service 21--we are receiving a lot of these denials.

These services have been billed for inpatient place of service 21.
The physician is not a radiologist but billed these services as interpretation and reporting as documented on the reports including appending modifier 26.

Is there any way to resolve/correct these denials for reimbursement/payment?...i.e. are there any replacement CPT codes for CPT 76604 and 76775 that are compatible with place of service 21?


Thank you in advance for your assistance!

 

[orthobiller2017]

Good morning all!
I have a question regarding CPT 76604--Ultrasound, chest and 76775--Ultrasound, retroperitoneal denials from Horizon BCBS due to invalid place of service 21--we are receiving a lot of these denials.

These services have been billed for inpatient place of service 21.
The physician is not a radiologist but billed these services as interpretation and reporting as documented on the reports including appending modifier 26.

Is there any way to resolve/correct these denials for reimbursement/payment?...i.e. are there any replacement CPT codes for CPT 76604 and 76775 that are compatible with place of service 21?


Thank you in advance for your assistance!

Bumping up

 

[csperoni]

Not my area of expertise, but I would suggest reaching out to the carrier. The coding seems correct with -26 if that is the test being performed and your physician is doing a full interpretation and report (not just like a wet read). My GUESS is that a radiologist may have also billed the interpretation.