Radiology Coding Alert

Question: We are coding/billing for a hospital-based radiologist. The patient is having a prostate biopsy done by the urologist. The radiologist is present for the entire procedure. The radiologist does a diagnostic prostate US, provides US guidance, and injects the left and the right neural vascular bundle. The urologist performs the actual percutanous biopsy. Can the radiologist bill 76942-26, 76872-26, and 64450 for the block? The urologist is billing 55700 for the biopsy.

Codify Member

Answer: For the radiologist’s services, you may report both the diagnostic ultrasound and the ultrasound guidance:

76872-26, Ultrasound, transrectal; Professional component

76942-26, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation.

You should be able to report the block performed by the radiologist, as well: 64450 (Injection, anesthetic agent; other peripheral nerve or branch). However, if a single physician performed both the biopsy (55700, Biopsy, prostate; needle or punch, single or multiple, any approach) and the block (64450) then payers who apply Correct Coding Initiative (CCI) edits would not reimburse 64450 separately. Because in your case the radiologist performed the block and the urologist performed the biopsy, the radiologist should be able to report the block.

Also look at whether the payer considers 64450 a unilateral code and whether you may report it bilaterally.