Radiology

Radiology Question for the Week of January 14, 2019

Radiology Compliance Question of the Week

Question:

What is the correct way to bill 76881 when imaging bilateral hands and feet? We get denials when we bill it in units. When we bill it as 76881-RT, 76881-LT, 76881-59-RT, 76881-59-LT, we get a denial for frequency. I researched and found that we can bill up to four times in one encounter. Is the coding correct, has the frequency changed?

Answer:

We question whether 76881 would be appropriate at all for bilateral hands and feet. This code is intended to be used for a complete evaluation of a single joint, not multiple joints in the hands and/or feet.

Medicare has a medically unlikely edit (MUE) of 2 for 76881, and the MAI (medically unlikely edit [MUE] adjudication indicator) is 3, which means that the Medicare Administrative Contractor (MAC) may override it if medical necessity is proven, but it may not be billed bilaterally.

If you are doing an arthritis survey of the hands and feet, unlisted code 76999 might be more appropriate.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.