Wiki thyroid biopsy coding problem

[Michele1229]

i need some help from my fellow coders.
i work at a diabetes and endocrinology practice.
i had an office visit code which i appended modifier 25 and they paid. the problem comes with the following 3 codes.
10022 is thyroid fna w/ ultrasound guidance
76942 is u/s guide for fna
76536 is u/s
we billed this way:
76942 denied 76536-59 paid 10022 paid in full
76942-51 paid 10022-59 paid 25%
76942-51 denied 10022-59 paid 25%
76942-51 denied 10022-59 paid 25%
am i using the wrong modifiers?? any advice?

 

[Nancy Peavler]

Thyroid biopsy coding

I do not do a lot of office surgery coding anymore so take this for what it is worth.

CCI edits says that if you do 99213, 10022 and 76942 on the same day all should be pain. If you do 99213, 10022, 76942 AND 76536 then the 76942 will be denied as it is a duplicate of the 76536. However, when I look up Needle Biopsy, Thyroid the CPT book leads me to use 60100 for the biopsy and add 76942 for the Ultra SOund. WHen you put the codes 99213, 60100 and 76942 in the CCI edit look-up it says all 3 of those will be paid. The CCI edits also says you can not use modifier 51 in either of these scenerios. So....check your office notes again and show the book to Doctor and be sure you have the correct code. Then put 25 on the office visit, if he truly did something besides decide to do the biopsy, like adjust their medication, talk about their hypertension or hair loss. THen list 10022 next with modifier 59 and your 76942 next. Not sure about a modifier with it. It has long been the thought that 51 was telling the insurance carrier "Hey, we did several of the same thing, pay me full price for #1 and only part of the fee for #2-??" So that being the case I would put 51 on the second ultra sound (if you did several biopsy) but not on the first one. If you did only one Ultra Sound I would not put a modifier on it.