Practice Management

Hello,

I have two questions:

1. Can you bill 76811 and 76819 on the same DOS? I know that the amniotic fluid vol. is included with 76811.  I would like clarification.
2. Is there a diagnosis cheat sheet for what dx codes can be billed with 76819.  We are getting denials for ICD-10 codes that I feel should be accepted. (eg. O09.33, O99.213). Can you use Z03.74, this one gets denied as well.  These are usually billed with 76816, 76805 and 76811.

Thank you so much for your help.

Penni Savignac, CPC

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Penni Savignac
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Hi Penni,

1. Yes, you can bill 76811 & 76819 on the same DOS as long as you have distinct indication(s) for each CPT. While not usually required, your payer may require to use -59 modifier on one CPT or the other to indicate that these 2 procedures were distinct.
2. The CPT guidance does not specify which ICD-10 diagnosis can be used for each. If you are getting denials in spite of using national recommended indications, I suggest appealing. For recurrent denials, I suggest speaking with the medical director of the payer.

Hope this helps

Fadi

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Fadi Bsat, MD, FAIUM
Chair, SMFM Practice Management Committee
Past Chair, SMFM Coding Committee
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Original Message:
Sent: 10-25-2023 11:50
From: Penni Savignac
Subject: Ultrasounds 76811 & 76819

Hello,

I have two questions:

1. Can you bill 76811 and 76819 on the same DOS? I know that the amniotic fluid vol. is included with 76811.  I would like clarification.
2. Is there a diagnosis cheat sheet for what dx codes can be billed with 76819.  We are getting denials for ICD-10 codes that I feel should be accepted. (eg. O09.33, O99.213). Can you use Z03.74, this one gets denied as well.  These are usually billed with 76816, 76805 and 76811.

Thank you so much for your help.

Penni Savignac, CPC

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Penni Savignac
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Mfm coder here, yes it can if there's indication and documentation to support both. I never have issues getting paid for both. The way you get paid for 76819 is by only using one primary dx. Here are the common icd codes z03.79, z03.74, z03.71, and twins icd codes. Like I said there is a trick to just using one icd 10 for this code. 

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Galina Tulman
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Original Message:
Sent: 10-25-2023 11:50
From: Penni Savignac
Subject: Ultrasounds 76811 & 76819

Hello,

I have two questions:

1. Can you bill 76811 and 76819 on the same DOS? I know that the amniotic fluid vol. is included with 76811.  I would like clarification.
2. Is there a diagnosis cheat sheet for what dx codes can be billed with 76819.  We are getting denials for ICD-10 codes that I feel should be accepted. (eg. O09.33, O99.213). Can you use Z03.74, this one gets denied as well.  These are usually billed with 76816, 76805 and 76811.

Thank you so much for your help.

Penni Savignac, CPC

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Penni Savignac
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