Wiki Articular injection w/ultrasound

[dawn.fenimore@my.sbc-stpeters.com]

When billing an Intra-Articular injection of BOTH ankles with ultrasound guidance, should coding be done as 20605 RT with 76942 and 20605 LT with 76942 ?? As you cannot bill 76942 bilaterally..

Alos, when billing Dx ultrasound 76881 does that include both ankles, or should we bill for each ankle??
HELP....

 

[ollielooya]

These are my thoughts on some of your particulars and will be interested to see if you get add'l posts.
I do know that MCR will NOT pay for 76942 as only one is allowered per DOS period. Other insurance companies that follow their guidelines will give the same result, but there are others out there that will pay.

Also by the nature of the code description for 76881 with the usage of extremity in the singular sense, would think that 76881 would be allowed twice. There is a note in your CPT book beneath that code to see CPT Changes, An Insider's View 2011, so if you have that edition you might want to start there.

 

[donnajrichmond]

When billing an Intra-Articular injection of BOTH ankles with ultrasound guidance, should coding be done as 20605 RT with 76942 and 20605 LT with 76942 ?? As you cannot bill 76942 bilaterally..

Alos, when billing Dx ultrasound 76881 does that include both ankles, or should we bill for each ankle??
HELP....

There is no standardization for modifiers and billing codes twice - you'll need to know how the particular payer wants it done. Or set a practice standard and adjust on the back-end if you get denials.
Medicare NCCI Policy Manual says that 76942, 77002, 77003, 77012, and 77021 can be billed only once per session, regardless of # of injections, biopsies, body areas, etc. But that's not a universal rule for other payers, and in fact, goes contrary to AMA and specialty society coding guidelines.

If complete bilateral medically necessary ankle diagnostic ultrasounds are ordered and performed, you would code 76881 twice, but again, whether that is 76881-RT, 76881-LT or some other way is payer dependent. If one ankle is comparison, you would not bill for that. It would be rare to have 76881 even once since it requires a lot of imaging, to have 2 complete exams would be even more unusual. If you have CPT Changes 2011, look at the list of what would need to be imaged for the ankle for 76881.

 

[ollielooya]

Donna, thanks for adding to this thead. You've helped us dig in deeper to establish what our policy should be concerning proper billing practices.