I agree, supercoder isn't the brightest coding tool available and I would rather go with Encoder but it was the only one available to our office for the available funds our department had. And yes, I would say it didn't exactly nail the inpatient stuff on the head by any means- I think they left out some info or I did when I copied the article- I was only intending to point out the verbiage from the thyroid biospy so maybe that was my fault and not supercoder. Anyhow, I have found several medicare and non-medicare and small insurance guidelines along with ACR and other accredited coding resources we are all probably familiar with. According to my doctors report, he only 'documented ultrasound guidance for one biopsy and failed to mention it again when he documented his other two biopsies so that was only coded once. I know the example below from American College of Radiology is referring to two breast nodules, which it seems as though they are taken from the same breast- as we have a right and left breast so wouldn't that technically be the same as a right and left lobe of the thyroid? All in a matter of opinion, of course, just like the rest of the articles below. I'm prepared to follow up with a denial if that be the case as medicare usually always requests supporting documentation and I'll have that. And come to think of it, I haven't even checked to see if the patient has medicare or not. I was just simply wanting to know the opinions of other coders on how they have coded situations such as this and it's a learning experience. So thank you for your opinion. It was much appreciated.
Version 15.3 of the CMS National Correct Coding Policy, Chapter 9, states in the Medically Unlikely Edits section:
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 the number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.
In the above statement, CMS allows one payment per encounter for needle placement guidance.
Medicare. To be in accordance with Medicare policy, code only one needle placement, according to the National Correct Coding Initiative (NCCI) guidelines. Also, remember this applies only to codes 76942, 77002, 77003, 77012, and 77021. Other guidance codes, such as mammographic (77032), stereotactic (77031), and catheter placement (75989) can be coded and modified with the -59 modifier as necessary for all payers.
Non-Medicare . For commercial insurance, consider applying modifier -59 or -76 if documentation supports the biopsy guidance procedures when reporting 76942, 77002, 77003, 77012, and 77021 for multiple lesions on the same encounter.
When multiple procedures are performed for different patient encounters on the same day, apply the appropriate modifier (-59) to distinguish payment for different encounters, including those involving Medicare patients.
Coding scenarios. Ultrasound-guided needle breast biopsy and stereotactic-guided needle breast biopsy: Your code for this ultrasound scenario will be 76942. Use 77031 with the -59 modifier on the stereotactic biopsy for all payers.
Two stereotactic needle breast biopsies: This concept would be 77031 and 77031 with the appropriate modifier -59, -76, -LT, or -RT (depending on carrier specifics) on the second guidance procedure code 77031.
Society instructions create confusion
CMS instructions state that billing for imaging guidance must be per encounter and not per lesion. However, society guidelines have always defined imaging guidance as per lesion or anatomical area involved, which has created confusion.
American Medical Association: Code 76942 should be per distinct lesion that requires separate needle placement (CPT Assistant, April 2005, page 16).
American College of Radiology: In describing ultrasound guidance for needle aspiration of two breast lesions (76942), ultrasonic guidance for needle placement is also reported twice because two lesions, one at the 2 o'clock position and the other at the 11 o'clock position, were treated. Note, it is the number of lesions sampled, and not the number of punctures, that is the determining factor on how many codes to report (Clinical Examples in Radiology, Fall 2008, page 3).
The Society of Interventional Radiology: The 2009 Coding Guidebook does not provide an opinion for how to code. “CMS has enacted MUEs (Medically Unlikely Edits), which limit the reporting of needle placement imaging guidance codes to once per session. The ACR and SIR are currently reviewing this issue as the code descriptors for the imaging guidance codes clearly state ‘biopsy' not ‘biopsies.' We will be exploring these edits with CMS to determine if they are appropriate or if the allowed MUE frequency unit should be increased,” it states.
This creates a bit of confusion, for now, as we must adhere to the CMS guideline and bill all of the listed imaging guidance codes only once per encounter for Medicare patients. If the specialty societies are successful in convincing CMS to increase the MUE unit frequency, then the coding can be revised.
As a reminder, charges that are denied for units in excess of the MUEs may not be billed to the beneficiary. The Advance Beneficiary Notice of Noncoverage (ABN) form cannot be used to seek payment from the beneficiary. s,
