Radiology Coding Alert

Question: Our physician used ultrasound rather than fluoroscopy for guidance when inserting a lumbar epidural catheter for post operative pain. Can we submit the ultrasound to the carrier? Which codes can we report for these services? 

Arkansas Subscriber

Answer: Medicare reimburses for ultrasound services when the services are within the scope of the provider’s license and are deemed medically necessary. Your physician may choose the imaging services depending upon clinical judgment in a particular situation.

Office services: In the office setting, a physician who owns the equipment and performs the ultrasound guidance, may report the global/non-facility code and report the CPT® code without any modifier, such as 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). The current national non-facility fee for 76942 based on the Medicare conversion factor of 35.8228 is $74.15, with a total national non-facility RVU of 2.07.

Outpatient or ASC services: If the site of service is a hospital or an ASC (Ambulatory Surgical Center), append modifier 26 (Professional component) to the CPT® code for the imaging service. That’s because even though 76942 isn’t approved for separate ASC payment to the facility, the physician will still get reimbursed for his work.  

Based on the Medicare Outpatient Prospective Payment System (OPPS), the technical component of image guidance procedures performed in the hospital outpatient department or ASC are considered a packaged service. This means that the payment to the facility for these services is included in the payment for the primary procedure.