Radiology Coding Alert

Question:

Arizona Subscriber

For the transrectal ultrasound, you should report 76872 (Ultrasound, transrectal). Be sure to append modifier 26 (Professional component) because you're reporting only the physician's services. For the guidance, you may report 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). Again, you should append modifier 26.

Best bet: Experts recommend that the radiologist include separate reports for the diagnostic evaluation (76872) and guidance (76942). You shouldn't need modifier 59 (Distinct procedural service). CMS deleted the edit bundling the codes retroactive to its 1997 introduction.

The urologist will report the biopsy using 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach).