Wiki Prostate biopsy/Transrectal Ultrasound denial

[almag69]

Our office bills for Prostate biopsies and we use codes 55700, 76872 and 76942.

In the last month I have had UHC and Aetna deny our 76872 code, is anyone else experiencing this?

I looked up the policy criteria and there are certain criteria to be met but we have been billing this way for years and never received a denial indicating not medically necessary.

Any information would be appreciated, thank you.

 

[TammyHF]

We are also getting those denials too.

We were told that the transrectal ultrasound is against Aetna policy but we could try appeal it showing it is a integral part of the prostate biopsy by documentation they may reconsider it. I don't know how that how that appeal process is going but I know we have had that issue since May or June.

As for UHC we have been able to appeal the TRUS biopsies after 7 but a couple of weeks ago we got a denial of a TRUS biopsy appeal stating we are not following their policy. We have asked for their policy showing the limited why they only allow 7 prostate biopsy samples.

If anyone is having any luck getting these paid PLEASE let me know.

Thank you!!!!

 

[jflynn124]

We have no problem getting these paid, we take 12 samples and bill 6 on one line and the other 6 on another line w/mod 59. UHC told us last year this is how they want them billed and we've had no problems ever since.