Wiki 76942

[lsauseda]

I need help!!

I have a doctor who does real time ultrasound injections. When we bill these out we use 76942 for the ultrasound and 20610 for the injection. Medicare has recently decided to deny 76942 charges for bilateral procedures. They'll pay both 20610's but not the 76942's. We've tried sending them out using 2 units, using RT and LT modifiers, with modifier 59 and they just keep getting rejected. Does anyone have any other suggestions as to what we can do?

Thanks in advance for your help.

 

[Isolis]

In an ASC we do not separarely bill 76942- Ultrasonic guidance for needle placement, imaging supervision and interpretation to Medicare. For Medicare this procedure is designated with a payment indicator of N1- packaged service/item; no separate payment made. I double checked the Medicare reimbursement payment rate, and it also list 76942 as N1 and payment $0; meaning Medicare will make payment on code 20610 only.

Hope this helps.

 

[OCD_coder]

76942 has an MUE limit of 1. You cannot bill it bilaterally or multiple times/units-RT/LT, bilaterally or with a modifier 59.