Wiki New Ultrasound modifiers for 76881?

[ollielooya]

Our MCR carrier changed from WPS to NGS at the beginning of September and our claims that contain an office visit with the 76881 are coming back with the 76881 being denied for "inconsistent with the modifier used or a required modifier is missing". We always submit with an LT or RT, but medicare rep just informed us they are looking for a "site" modifier as required by the CCI editis? We are also aware of the use of modifier 26 and TC. What are we missing and what is MCR looking for? Prior to September 7, had no problem with these types of claims being processed.

 

[johnmeyer]

I'd be interested in knowing as well since I'm gettting conflicting information on how to bill for ultrasound guidance.

I was told that we had to use -LT/-RT modifiers and that we could bill once per side, but that was all. Now I'm being told you can only bill it once no matter how many times or sides it was used for without the use of laterality modifiers. :-(

 

[ollielooya]

Hi John,
I was given the information by NSG MCR that the issue had to do with the "site" and that LT and RT were not necessarily what they were looking for but due to 9/7/13 edit revisions, the way that we had billed it before (one unit with either LT or RT), would generate denials. So I pulled the afore-mentioned LCD on it, and found that INDEED they do want it billed with LT or RT, so what gives? Is this a case an error on their side? Should I toss their own LCD on it to get these line items paid? What's the procedure? Reopening? Redetermination? We just migrated from WPS to NGS and wonder due to this recent change if there might be some edits placed wrongly in the system, and if so, HOW do we go about getting them corrected? Hopefully others will join in here.

 

[mitchellde]

Have you tried a 50 modifier when you do both sides? Many Medicare and Medicare replacement plans require the use of 50 for bilateral procedures bill with 1 unit.

 

[ollielooya]

Hi, Debra, thanks for your input, but in this particular case it is one-sided. I did find a revision to the LCD effective 9/7/2013, yet it still validates that LT or RT can be used. So guess I just use this article as a basis to deal with MCR?