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Double Ultrasound Codes Spell Double Trouble With Auditors

Posted on 25. Oct, 2009 by in Hot Coding Topics

Authorities scrutinize medical necessity for 76830 & 76856.

The OIG is watching your ultrasound orders and code combinations — and it doesn’t like what it sees. Take note of these problem spots to keep your claims in the clear.

An OIG audit of ultrasound services billed in 2007 found that nearly one in five ultrasound claims “had characteristics that raise concerns about whether the claims are appropriate,” according to a July 2009 audit report titled “Medicare Part B Billing for Ultrasound.

The most common error: Roughly 17 percent of 2007 Part B ultrasound claims lacked prior service claims by the ordering physician, the OIG indicated.

What this means: Several physicians ordered ultrasounds for patients that they hadn’t treated within the last year. “The OIG would wonder why the doctor would order an ultrasound for a patient who [the ordering physician] hasn’t examined,” notes Allison...

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