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 would question whether 76881 would be appropriate at all for bilateral hands and feet. Code 76881 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 (MUE adjudication indictor) is 3 meaning that the Medicare administrative contractor (MAC) may over-ride 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.

Facebook
Twitter
LinkedIn
Email
Print

CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.