# 76942 medicare denial



## mconnolly (May 16, 2014)

Our orthopedic has been billing 76942 with 20610 for over a year and have been getting paid.  Mdcr now is denying stating that this code is only allowed by a radiologist/podiatrist/urologist. Has anyone else been getting any denials for this and is there another code that we can use for medicare?


----------



## MarcusM (May 16, 2014)

AAPC Coder Tool: Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)	
Notes:
(If imaging guidance is performed, see 76942, 77002, 77012, 77021)

HOWEVER....
http://www.aaos.org/news/aaosnow/jul13/managing2.asp
offers the following information:

Injections with ultrasound guidance 
Q: Can the ultrasound guidance CPT code—76942—be reported when the physician performs a major joint injection (CPT code 20610) using ultrasound guidance?

A: There is no AMA CPT coding restriction to reporting CPT code 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation) when ultrasound guidance is medically necessary to accurately place the needle for the injection. However, in most cases, imaging guidance to penetrate an easily palpable joint seems neither reasonable nor necessary.

CPT code 76942 has both professional and technical components, meaning that a separate radiology report (not part of the procedure note) is required to meet the code’s radiology requirements. The specific documentation requirements for ultrasound guidance include the following:

A final, written report should be issued for inclusion in the patient’s medical record.
Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized.
Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.
Although reporting code 76942 with the joint injection code 20610 is permissible, many payers are denying this service as not medically necessary. For example, under the Florida First Coast Medicare local coverage determination (LCD) 29307, “Imaging procedures performed routinely for the purpose of visualization of the knee to provide guidance for needle placement will not be covered. Fluoroscopy may be medically necessary and allowed if documentation supports that the presentation of the patient’s affected knee on the day of the procedure makes needle insertion problematic. No other imaging modality for the purpose of needle guidance and placement will be covered.”

Other Medicare carriers, such as National Government Services, have initiated payment recoupments for CPT code 76942 on the basis of lack of medical necessity.


----------



## mconnolly (May 19, 2014)

That's great, thank you i will show to my docs.


----------

