CPT Code 76937 x2

[Shauswald]

We are billing ultrasound guidance 76937 x 2 when performing two procedures (line placements or pain procedures). I am trying to ascertain if it correct coding to bill this service (76937) twice as we are receiving denials stating we are only allowed to bill 1 per day.

Thank you

 

[LisaAlonso23]

76937 is billed when US is used for visualization for vascular needle entry. It's also an add-on code that may not be billed alone.

If you're billing it with 37191, 37192, 37193, 37760, 37761 or 76942, it will definitely deny. As stated in the CPT manual, you may not report 76937 with any of those codes.

76942 is billed when US is used for needle placement for injections for pain management (some codes include visualization, so you will need to reference the CPT manual to see if it's bundled). Also, you may refer to page 460 of the 2017 CPT manual for the long list of codes you may not report with 76942.

Generally, each would require a modifier of 26 if performed by the surgeon.

Additionally, if there are two procedures done (ex, 2 pain injections), you may only bill US once.

I hope this is helpful.

 

[kschance@gmail.com]

Stephanie

Do you know of anywhere that there are guidelines for billing 76937? Our doctors do CVC's and they use US guidance. One of our billers was recently told during an AAPC webinar that doctors can not bill 76937 just for convenience, that they must document the medical necessity. However, I am not able to find this anywhere and my doctors are wanting something in writing telling them this is the case. I am being told that they use the guidance as a standard of care. Can anyone help with a guideline?

 

[LisaAlonso23]

I recently came across the following document. I hope this helps.

file:///H:/Downloads/practice-guidelines-for-central-venous-access.pdf

Make sure you're billing the first 76937 with a -26. Then, the second 76937 is billed with -76, 26.