March 31, 2016
We used an outside coding consulting company (not yours!) to review some notes. They told us we could bill 76998-26 for intraoperative ultrasound when we also bill for a brain tumor removal (e.g., 61510, 61512). We tried it on a couple of claims and we were paid. But now one of the insurance companies is requesting a refund. Should we return the payment? It wasn’t very much money. But if they want the money back, it makes me think we shouldn’t have billed it. But that coding company said we could!
Yes, you should return the money. The AANS says that intraoperative ultrasound is included in the global surgical package for the neurosurgery codes and it makes sense. If you’re going to bill for removing a brain tumor then you’re expected to find it after the incision has been made and you’re in the operative field. Do not report 76998 (Ultrasonic guidance, intraoperative).
*This response is based on the best information available as of 03/31/16.