# 76942/77012/76377



## margaret fahy (Apr 9, 2014)

Hey Guys,
Does anyone have insight into billing for 3D Recons for a TMJ Injection when dr. also documents US guidance and Cone Beam CT images.
If it were just Cone Beam CT and US Guidance, I would bill for the US Guidance, as this is the primary code; however, with the documentation of 3D, now I'm not sure what to bill for guidance....Question: it appears that 3D is part of Cone Beam CT.....so would I still bill just the primary guidance code...76942?
Any input would be greatly appreciated.
Thanks.....Margie

CLINICAL HISTORY: Polyarticular JRA

COMPARISON: MR February 28, 2014

PROCEDURE TIME: 15 minutes

WEIGHT: 24 kg


PROCEDURE: Limited ultrasound of the right TMJ was performed to
choose a site for insertion of the needle. The skin of the right
pre-auricular area was prepped and draped in sterile fashion and
local anesthesia using 1 mL of 1% buffered lidocaine was infused
at the insertion site. Using ultrasound guidance a 25-gauge
needle was inserted into the right TMJ. Coned beam CT imaging was
performed to confirm intra-articular positioning of the needle.
Once position of the needle within the joint was confirmed 0.5 ml
(10mg) of Aristospan was injected into the joint. The needle was
then removed. The site was dressed with a Bandaid. There were no
complications and the patient left the IR suite in stable
condition.  Dr. McIntosh was present for the entire procedure.

Permanent ultrasound and cone beam CT images were obtained and
stored in the PACS system. 3-D coned beam CT images were acquired
and reconstructed at a separate workstation by the interventional
radiologist performing the procedure. These images were essential
in determining intra-articular positioning of the needle prior to
injection of steroid suspension.

IMPRESSION
 Successful, uncomplicated right TMJ injection. 

Results


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## jkayser (Apr 15, 2014)

Please take a look at CPT 76377 to see if it is appropriate.  Here is the description from EncoderPro:

3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation 

I hope that helps.

Jean Kayser CPC CIRCC


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## margaret fahy (Apr 15, 2014)

Jean,
Thanks....
I am wondering if 3D is an integral part of 77012.  I think it is, but I cannot find any info in my CSI book or Endcoder Pro with respect to bundling.
For the report I entered with the question, I would up billing 77012 as the guidance, over 76942 and did not bill 76377.
What do you think?
Margie


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## jkayser (Apr 15, 2014)

Hi, here is a link to a WPS CMS document that addresses the issue and states that the base imaging procedure code must also be billed with 76377.  

http://downloads.cms.gov/medicare-c...achments/30729_1/L30729_RAD037_cbg_060110.pdf

See what you think.  

Thanks.

Jean Kayser CPC CIRCC


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