Radiology Coding Alert

Question: Our radiologist used CT guidance to biopsy a pancreas mass, but the mass kept moving, so the physician had to resort to using ultrasound guidance. He wants to report 76360 for the CT, 76942 for the ultrasound, and 48102 for the biopsy. Can he report all three or just the biopsy and ultrasound?

Answer: The National Correct Coding Initiative (NCCI) considers 76360 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation) a component of 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).

While complex procedures sometimes demand multimodality guidance and monitoring, you should usually report only the most comprehensive imaging service that the radiologist uses or the modality that was ultimately successful. In your case, therefore, you should report 48102* (Biopsy of pancreas, percutaneous needle) and 76942 for the ultrasound.

But there are cases when the physician might biopsy two separate components of a mass using unique forms of guidance as necessitated by the anatomy and/or pathology in question. In such cases, you should report both forms of guidance and append modifier -59 (Distinct procedural service) to 76360 (the bundled procedure). The operative report should clearly document the extenuating clinical circumstances that required the multi-modality approach.