tci Part B Insider - 2011 Issue 17

Reader Questions: Look to Modifier 59 When Reporting These Codes Together

Question: Can we bill 76856 together with 93975 using modifier 59?Answer: Yes, you may report the two codes together when documentation supports that choice. Correct Coding Initiative edits bundle 76856 (Ultrasound, pelvic [nonobstetric], real time with image documentation; complete) into 93975 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study). The edit's modifier indicator of 1 means that you may override the edit in appropriate cases. You should append modifier 59 (Distinct procedural service) to 76856 when documentation supports overriding the edit.Before you consider reporting both codes, verify...

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