According to this article, either 76942 or 76872 can be coded with 55700 but not both. There's conflicting information about this because when I looked at CPT Assistant, July 2022, Volume 32, it says both can be billed, but the clinics I work for say to only bill one or the other.
CMS to Uphold Edit to Bundle Transrectal Ultrasound and Ultrasonic Guidance (auanet.org)
Correct Coding Solutions, Medicare contractor for the National Correct Coding Initiative (NCCI), has issued their final decision to bundle CPT code 76942
Ultrasonic guidance for needle placement paired with CPT codes describing diagnostic ultrasound procedures (specific for urology, CPT code 76872 Ultrasound, transrectal). Their decision was issued in a November 17, 2016 letter to the AUA after AUA questioned the contractor’s original edit that was implemented on July 1, 2016. The AUA also had participated on a conference call with the NCCI and Center for Medicare & Medicaid Services (CMS) representatives and requested that the edit be removed stating that these imaging procedures are performed for separate and specific reasons. The AUA believed that the edit would create erroneous denials.
However, after several attempts by the AUA to change the edit, CMS has updated the 2017 version of the National Correct Coding Initiative Policy Manual with the codes bundled. The following has been posted to the CMS NCCI website stating in Chapter 9 Radiology, Section H General Policy Statements, “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. Physicians should not avoid these edits by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service."
The AUA is recommending that providers should consider reporting either CPT code 76872 Ultrasound, transrectal; or CPT code 76942 Ultrasonic guidance for needle placement based on the procedure performed and 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.
If you have any questions regarding this, please contact the AUA Coding Hotline at
codinghotline@AUAnet.org or 866-746-4282, option 3.
