CPT code 76942

[Monika Liddle]

Hi,

During the National Conference in Jacksonville, at one of the session it was stated that CPT code 76942 is only allowed to be billed once per operative sesssion. Does anyone know where that guideline is? I did not write it down.

Thank you

Monika

 

[preserene]

ultrasound guidance reporting allowed once only-When?

Ultrasound guidance reporting allowed once only per examination session:
The beginning sentence of Page 322 of the CPT Manual says” if less than the REQUIRED ELEMENTS FOR A “COMPLETE”EXAM ARE REPORTED(EG, LIMITED NUMBER OF ORGANS OR LIMITED PORTIONS OF REGION EVALUATED ), THE LIMITED CODE FOR THAT ANOTOMICAL REGION SHOULD BE USED ONCE PER PATIENT EXAM SESSION. A limited exam of an anatomic region should not be reported for the same exam session as a”complete” exam of that same region.
For( eg ) 76942, 76945 (those codes series), the exam session is not complete. They are only diagnostic Guidance which is a component or a portion of the “complete” Exam session. It makes sense just as the term “limited” portion of the region evaluated. They are not noted as separate procedure too.
Please see the notes just down the code76945 description in parenthesis, ( For procedure, use 59015).
So procedure is yet another required element. The examination becomes “COMPLETE” only when the procedure is also reported or listed along with.
So long as the Ultrasound diagnostic guidance does not “complete' the exam requirements, as per the guideline rules , it can be used ONCE only per patient exam session.
I hope I make the right sense of the quote!
Thank you.

 

[Lisa Bledsoe]

I didn't attend that session apparently...this is per CPT assistant:
April 2005 page 16
Coding Consultation:Questions and Answers

Radiology, 76942 (Q&A)

Question

Would it be appropriate to report code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation, twice when there is more than one lesion in the breast?

AMA Comment

From a CPT coding perspective, code 76942 should be reported per distinct lesion that requires separate needle placement. Therefore, if several passes are made into two separate lesions in the same organ (ie, two lesions in same breast), then code 76942 would be reported twice.

 

[Monika Liddle]

Thank you for your responses.

Per CCI guidelines (version 15.3, Radiology G3) this is what I finally found:

3. CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.

 

[Lisa Bledsoe]

Aha - see the difference between AMA and CMS? No wonder we get confused...

 

[Monika Liddle]

It is very hard to keep things straight. This is why I like the list serves, getting other coders opinions.

Thanks

 

[preserene]

CPT Code 76942

That is a real confusing Challenge and that the final ‘judges’ for payment -the payers are there, to meddle with !!!?.
As for my perception, the SAME “ANATOMICAL REGION” evaluation, not the number of lesion and the number of injection/introduction that matters, for SELECTION of number of times of reporting (once or twice) meaning that we would report only once, even if 2 ,3. 4 5 and on … LESIONS are seen OR SAMPLED by Ultrasound in the same breast/Anatomical region in that exam session.
For eg, take the ‘Chorionic Villi Sampling diagnostic Ultrasound. The physician may search for ends/ mid portion ’ /upper or lower border, whether at the lower portion of the uterus or cervix and selection needs number of searches and number of samplings for a better outcome, yet ,we would code only once in that ‘sitting’ or ‘examination’ .
I think/rather feel that AMA and CMS authorities together come for our RESQUE NOW!!
Thank you, you all did well on this session for enlightening.