Cardiology Coding Alert

Question: I’m hearing conflicting things about whether I can report 76942 for needle placement guidance in the office. When is it OK?

Florida Subscriber

Answer: As a Florida coder, your question probably relates to recent coverage news from your MAC First Coast. Not long ago, First Coast alerted its providers that 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) was not priced for the sorts of procedures typically performed in offices and so an unlisted procedure code would be more appropriate than 76942 for that setting.

First Coast has rescinded that policy (http://medicare.fcso.com/Coverage_News/256934.asp). The MAC will be making claim adjustments, but claims denied as not reasonable and necessary will keep that status.

Keep in mind: This change is not a free pass to automatic 76942 payment. First Coast maintains that documentation must support the ultrasound guidance used for a particular case, and this MAC is not alone. As First Coast says in its coverage news post, “On audit, if the documentation does not support that the ultrasound guidance provided clinical value, the claim will be denied.” And because 76942 is an S&I code, the medical record must also include an interpretation of the guidance. First Coast says that because non-physician practitioners (NPPs) aren’t qualified to provide an interpretation, they aren’t expected to report 76942.

Also be sure to check whether local coverage determinations (LCDs) for certain procedures mention ultrasound guidance. For instance, Florida LCD L29298 for lower extremity varicose vein treatment states, “Procedure code 76942 represents a service that is not covered by Medicare for the purposes of this LCD.