Radiology Coding Alert

Question: I performed ultrasonic guidance during a prostate biopsy. Can I bill for both the guidance and the transrectal echography?

Mississippi Subscriber

Answer: The National Correct Coding Initiative (NCCI) does not bundle 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) and 76872 (Echography, transrectal), so you should report both codes if you indeed performed both studies. Specifically, if you perform the transrectal ultrasound only to provide biopsy guidance and you do not perform a full and complete prostate ultrasound, you should report only 76942. If you perform a full and complete prostate study (including characterization of glandular tissue and gland measurement) in addition to the guidance, you should code both the guidance code and the transrectal ultrasound study.

If the radiologist also performs the biopsy, you can also report 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach). Your documentation must clearly support the performance of each individual service and the medical necessity for performing both the diagnostic ultrasound and the procedure with guidance during the same session.