Orthopedic Coding Alert

Question: Is it correct, according to CPT®, that there are restrictions while reporting ultrasound-guided joint injection? What other points should I consider while coding a joint injection with ultrasound report?

New York Subscriber

Answer: No. There is no AMA CPT® coding restriction to reporting CPT® code 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) when ultrasound guidance is medically necessary to accurately place the needle for the injection. However, in most cases, medical practitioners find it unreasonable and unnecessary to use imaging guidance for penetrating an easily palpable joint.

CPT® code 76942 contains both professional and technical components, meaning that a separate radiology report (not part of the procedure note) is required to meet the code’s radiology requirements. The specific documentation requirements for ultrasound guidance include the following:

• The patient’s final medical record should include a final, written report.
• Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized.
• Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.
• Although you may report code 76942 with the joint injection code 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), many payers are denying this service as not medically necessary. 

Other Medicare carriers, such as National Government Services, have initiated payment recoupments for CPT® code 76942 on the basis of lack of medical necessity.