Wiki 76642 bundled to 19083?

[Melyssa724]

I have several claims where a general surgeon is billing for a breast biopsy w/placement of localization device and ultrasound guidance (performed in the office) who also bills for a limited ultrasound. I review the E/M and it does not indicate that an ultrasound was performed on the breast PRIOR to the biopsy being performed to locate the mass. Only a physical exam was performed to locate the breast mass and mammogram findings reviewed.

Am I correct in stating that the ultrasound is included in the breast biopsy as the CPT describes and the physician cannot bill for a limited U/S separately?

Thanks for any feedback!

 

[CodingKing]

yes its bundled. The code description and RVU includes the ultrasound guidance

 

[bmyers]

76642/19301-19086

We are experiencing this also with our general surgeon. The patient is scheduled for a breast biopsy but he feels that he has to do an ultrasound to make sure he is get the right position to put the biopsy device needle in. He feels that he needs to do this before he biopsies, 19301-19086. Our provider dictates a seperate note from his biopsy note for this ultrasound. Do you still think it is included?

 

[CodingKing]

We are experiencing this also with our general surgeon. The patient is scheduled for a breast biopsy but he feels that he has to do an ultrasound to make sure he is get the right position to put the biopsy device needle in. He feels that he needs to do this before he biopsies, 19301-19086. Our provider dictates a seperate note from his biopsy note for this ultrasound. Do you still think it is included?

The following was added to the NCCI Manual since people were miscoding the additional guidance codes. Its expected that radiological guidance would be used to perform the procedure which is why its bundled.

2016 NCCI Manual - Chapter 3, L.18

18. If the code descriptor for a HCPCS/CPT code, CPT Manual instruction for a code, or CMS instruction for a code indicates that the procedure includes radiologic guidance, a physician should not separately report a HCPCS/CPT code for radiologic guidance including, but not limited to, fluoroscopy, ultrasound, computed tomography, or magnetic resonance imaging codes. If the physician performs an additional procedure on the same date of service for which a radiologic guidance or imaging code may be separately reported, the radiologic guidance or imaging code appropriate for that additional procedure may be reported separately with an NCCI-associated modifier if appropriate.