Neurology & Pain Management Coding Alert

Question: If our provider performs an ultrasound guided procedure (76942) on the same date of service as an ultrasound diagnostic exam (76881 and/or 76882), will both be reimbursed?

Oregon Subscriber

Answer: Yes, you should be able to report diagnostic ultrasound exams 76881 (Ultrasound, extremity, nonvascular, real-time with image documentation; complete) or 76882 (… limited, anatomic specific) during the same encounter as 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). Just verify that the usual requirements (orders, medical necessity, supporting diagnoses, etc.) are met and well documented before filing the claim.

Watch: Code 76942 has numerous procedures that should not be reported on the same claim, such as 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed), 64479-64484 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT] …), and 0213T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance …). Always check whether the codes in question are mentioned in the parenthetical notes as one way to verify that you’re reporting procedures correctly.

Also note: Although the Correct Coding Initiative (CCI) edits don’t bundle these codes, Chapter 9 of the Medicare NCCI Manual includes the following directive regarding separately reporting a diagnostic ultrasound as well as needle guidance: “Ultrasound guidance and diagnostic ultrasound (echography) procedures may be reported separately only if each service is distinct and separate. If a diagnostic ultrasound study identifies a previously unknown abnormality that requires a therapeutic procedure with ultrasound guidance at the same patient encounter, both the diagnostic ultrasound and ultrasound guidance procedure codes may be reported separately. However, a previously unknown abnormality identified during ultrasound guidance for a procedure should not be reported separately as a diagnostic ultrasound procedure.”