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Billing 76942 multiple times

  1. #1
    Default Billing 76942 multiple times
    Medical Coding Books
    Can 76942 be billed multiple times for a needle core breast biopsy (19102)....3 different sites. (10, 1 and 3)

    If so, what modifier should I attached. 59 or 51


  2. Default CMS/ACR/CPT/IVR Guidelines/client specification
    My inputs

    Pls refer:
    The issue is that the National Correct Coding Initiative Policy Manual for Medicare Services, Version 14.3, was updated in October 2008 with the following paragraph (page 9): 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.

    The CMS instruction is that imaging guidance is billed once per encounter and not per lesion. Society guidelines have always defined imaging guidance as reported per lesion or anatomical area involved.

    This edit will allow use of NCCI associated modifiers if 76942 is utilized for a separate procedure unrelated on the same date of service
    Pls refer

    American Medical Association:
    From a CPT coding perspective, code 76942 should be reported per distinct lesion that requires separate needle placement. (CPT Assistant April 2005, page 16)

    If coded in accordance with CPT assistant-need to add 59 mod for each additional lesion(distinct).

    American College of Radiology in describing ultrasound guidance for needle aspiration of two breast lesions:
    Code 76942, Ultrasonic guidance for needle placement, also is reported twice because two lesions one at the 2 o'clock 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 in their 2009 Coding Guidebook has not given their opinion on how to code. They state:
    CMS has enacted MUEs (Medically Unlikely Edits) which currently 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. (Pages 277 - 278)

    ZHealth recommends following the CMS guideline and billing all of the listed imaging guidance codes only once per encounter for Medicare patients.

    As the guidelines differ, I'd assign as per the client specification (query ,either to follow CMS/ACR/CPT/ or IVR Guidelines?) & the modifier use depends accordingly.

    Last edited by msrd_081002; 01-02-2011 at 08:31 PM.

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