07/24/2018

Correct Coding for CPT 76882 and 20600-Medicare

Insurance Empire Medicare. If I perform and single site diagnostic ultrasound (76882-Lt) on a patient and on the same visit I inject the joint (20600-Lt) that I diagnosed with the ultrasound, but do no use the US to guide the injection I get a rejection code 236 ( procedure/ modifier not compatible with another procedure/modifier on the same day). on the ultrasound procedure.

The ultrasound was denied by Medicare because according to current CCI edits, CPT 76882 is considered a component of the injection code 20600. In order to be reimbursed separately for the radiology service, Modifier 59 would need to be appended to CPT 76882 and a corrected claim would need to be sent to Medicare. Adding the modifier should resolve the issue with payment without filing a redetermination to Medicare to justify separate payment.