Radiology Coding Alert

Question: I saw January's article "This Simple Trick for Coding Mammographic Guidance Will Earn You Big Bucks," which says to report stereotactic localization and mammographic guidance for breast biopsy or needle placement for each lesion. We use ultrasound guidance, so we report 76942. Should we report this code per lesion, too?


Indiana Subscriber


Answer: Like so many coding questions, this decision is left to the payer's discretion, but there are some that allow you to report one unit of 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for each lesion you address.

When your payer's policy is unclear, ask them to send you a clarification in writing.

If you are allowed to report 76942 per lesion, remember that this really does mean per lesion. You should not report guidance based on the number of samples the physician takes. And make sure the documentation clearly shows that each lesion you coded for is separate and distinct.