CPT code 76942: Ultrasonic guidance Needle Placement NonVascular

CPT code 76942 is an diagnostic ultrasonic guidance code for needle placement. This code is used mostly for the percutaneous procedures. Percutaneous surgeries are same day surgery procedure and minimal invasive procedures. These procedures are performed through the skin percutaneously. Hence, guidance is always required for the procedure cpt code. Like Procedure code 76942, there are the other type of guidance as well depending on the type of guidance is used. For fluoroscopic guidance, we have 77001, 77002 and 77003 CPT code and depending on the kind of the procedure, we will use the guidance code.

There are different guidance codes used for vascular and non-vascular procedures. CPT 76942 is used for diagnostic ultrasound guidance non-vascular procedures. For vascular procedure, we use CPT code 76937 hence it should not be confused with 76942 CPT code. Now, let us check how and when to use CPT code 76942 to avoid the error with this code.

Image courtesy:http://paragonsportsmedicine.com/procedures/ultrasound-scan-diagnostic-guidance/

When to use Procedure/CPT code 76942 (Ultrasonic guidance for Needle placement)

The Ultrasound/ultrasonic guidance or any other guidance code cannot be used primary; it should have a primary main procedure code for which the guidance is used. For example, if an arthrocentesis procedure is done with the use of guidance then the arthrocentesis CPT code should be primary followed by the guidance code, like 20610 and 76942. Many of the CPT codes now include the guidance codes; hence, we should be careful while assigning the CPT codes. CPT 76942 is an ultrasonic guidance for needle placement for procedures like biopsy, injection, aspiration etc.hence it should be used only with these procedures. Therefore, all the biopsy, spinal injection, joint injection, aspiration procedures will use ultrasound guidance 76942. Also Fine needle aspirations are also done with the help of this guidance.

Also as per CMS NCCI coding guidelines, “Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same or different patient encounter(s) on the same date of service are not separately reportable. For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement…) when performed in the same anatomic region on the same date of service.

Hence, either of the procedure should be reported when CPT code 76872 Ultrasound, transrectal; or CPT code 76942 Ultrasonic guidance for needle placement are performed, based on the documentation in the patient’s chart. A modifier should not be used to unbundle this coding scenario as it has been deemed inappropriate coding.

Reimbursement :Most medical insurance plans cover ultrasound studies when they are indicated as medically necessary. However, Medicare and private payers may have different requirements. Private insurance payment rules vary by payer and plan as regards which specialties can perform and receive reimbursement for ultrasound services. Ultrasound providers face risk of denied claims and even audits if they are not knowledgeable about coding and billing rules and payer guidelines.

The following from CPT Assistant defines what would NOT be billable: “…for those instances when ultrasound is utilized only to identify a vein, mark a skin entry point, and proceed with a non-guided puncture, it would not be appropriate to report code 76937 for ultrasound guidance.”

Use of 76942 CPT code for Bilateral exam

As per Medicare NCCI Policy Manual, CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.

For Medicare you would therefore report only 1 unit of 76942, even though 2 lesions were biopsied. Other payers, you need to check with them for multiple units of units of 76942. However, it would be better to use CPT code 76942 without 50 modifier, till their is clear coding guideline for use of multiple units.

For example, If a physician performs a lung biopsy with ultrasonic guidance in the morning and then again the physician perfroms a thyroid biopsy with ultrasound guidance in the evening in separate encounter. The CPT codes will be reported as below:

Morning: 47000, 76942

Evening: 60100, 76942-XU

Since the physician performs both biopsy in different encounter, you can billed the ultrasonic guidance for both with a XU modifier.

While coding for physicians the medical coders can append 26 modifier with CPT code 76942 for diagnostic ultrasound. The 70000 series codes are from radiology chapter and hence the ultrasonic/ultrasound guidance codes can be reported with 26 modifier.

Use Ultrasonic Guidance CPT code 76942 only as Secondary code

Ultrasound guidance are used for performing percutaneous surgeries. Hence, most of the procedures like thoracentesis, breast biopsy, Myelogram, spinal epidural injection etc. needs the help of guidance for performing these procedures. Hence, the primary code is always the surgery procedure code followed by the guidance code like 76942. Most of the major procedures have now bundled the guidance including the breast biopsy and spinal injection procedures, hence be careful while using the guidance codes.

There are a separate list of ultrasound procedure codes in radiology which are used as primary codes.

Difference between Ultrasound guidance CPT code 76937 and 76942

In interventional radiology coding, we have two ultrasound guidance code for vascular and non-vascular procedures. For vascular procedures like central venous catheter placement, angioplasty, thrombectomy, AV fistula procedure the medical reports have to report procedure code 76937 as ultrasound guidance. Three important criteria should be met in documentation for coding guidance code 76937.

Patency of the blood vessel
Recording of images
Under ultrasound guidance documentation

For Non-vascular procedures like arthrogram, arthrocentesis, biopsy, etc the medical coders have to report CPT code 76942 as ultrasound guidance.

Do and Don’t about CPT code 76942

CPT code 76942 should be coded once per encounter

Do not use CPT code 76942 for vascular procedures; separate ultrasound guidance code 76937 is used for these procedures.

Do not use any modifiers like RT, LT, 59, 51 etc with CPT code 76942. Modifiers are not eligible with CPT code 79642.

Do not report 19281-19288 in conjunction with 19081-19086, 76942, 77002, 77021 for same lesion. Placement of breast localization device procedures inlcudes the mammographic guidance, stereotactic, MRI and ultrasound guidance.

Do not report 20600, 20604 in conjunction with 76942, 0489T, 0490T. Arthrocentesis CPT codes have separate code for with and without ultrasound guidance, hence CPT code 20600 will be reported for without ultrasonic guidance and CPT code 20604 will be reported for with ultrasonic guidance exam.

Do not report 49083 in conjunction with 76942, 77002, 77012, 77021. CPT code 49083 is reported for abdominal paracentesis exam which includes imaging guidance.

Do not report CPT code 20610, 20611 in conjunction with 27369, 76942

Do not report 45392 in conjunction with 45378, 45391, 76872, 76942, 76975. This colonoscopy exam includes the ultrasound guidance hence should not be reported separately.

Do not report 10030 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021. CPT code 10030 includes the ultrasound, fluoroscopic, CT and MRI imaging guidance, hence should not be reported separately.

Do not report 49407 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021. CPT code 49407 includes the ultrasound, fluoroscopic, CT and MRI imaging guidance, hence should not be reported separately.

Do not report 37760, 37761 in conjunction with 76937, 76942, 76998, 93971. CPT code 37760, 37761 includes the use of ultrasonic guidance, when performed.

Do not report 62321 in conjunction with 77003, 77012, 76942

Do not report 45342 in conjunction with 45330, 45341, 76872, 76942, 76975

Do not report 55874 in conjunction with 76942

Do not report 49406 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021

Do not report 49084 in conjunction with 76942, 77002, 77012, 77021

Do not report 32554-32557 in conjunction with 75989, 76942, 77002, 77012, 77021. Use Thoracentesis CPT code 32554 if the procedure is performed without imaging guidance. Use CPT code 32555 when imaging guidance is used during the procedure.

Do not report 62323 in conjunction with 77003, 77012, 76942

Do not report 10005, 10006 in conjunction with 76942