# Ultrasound guidance for nerve block needle positioning



## gmacdonald (Oct 19, 2010)

I'm being asked about charging / potential revenue for using Ultrasound guidance for nerve block needle positioning.  Does anyone have any experience with coding these procedures ?
Are we looking at coding the anesthetic injection (the CPT 64400 - 64455 series) based
on the nerve being injected and adding an the "unlisted" ultrasound procedure code ?
Can't find anything more specific ?

Thanks.


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## JWash618 (Oct 19, 2010)

I dont know if this helps you at all but with my groups we charge 76942 PER BLOCK as long as it is in a different location (and is documented as USG)
for example after a TKA they do a 64445 and a 64447 both USG I code it this way:
76942, 64445-59, 76942, 64447-59

I dont know anything about the reimbursment part of it though. Hope it helps a little!


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## dwaldman (Oct 19, 2010)

http://www.gehealthcare.com/usen/community/reimbursement/docs/AN2010ReimbursementGuide.pdf

You could compare to reimbursement 77002 From looking at the PDF the Ultrasound code 76942 looks higher. It interesting that they have bundled 77002 in many of the code range you mention, but the couple I looked at they did not also bundle 76942. I don't know carriers response with payment for this code or the documentation requirements because I have never billed for it.


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## ohiocoder101 (Oct 19, 2010)

we use the 76942-26 for the guidence whenever it is used along with the 6444x codes, majority of insurance companies pay. have seen a few they deny but we send documentation, then its paid

hope this helps


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## missyah20 (Oct 22, 2010)

Make sure that your providers have good documentation and an ultrasound picture on file.


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## jdrueppel (Oct 24, 2010)

We also bill 76942-26 (professional component because we don't own the ultrasound equipment) for ultrasound guidance of block placement and have recently addressed this issue.  Per NCCI CPT code 76942 is per encounter not per needle localization.  So if more than one block is placed during the same "encounter" the ultrasound guidance code of 76942 is only billable x1.   I have attached the excerpt from NCCI Chapter 9 below for your review.

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.

Julie D, CPC


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## dwaldman (Oct 25, 2010)

Good point> I didn't realize that the original question had 76942 per block.


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