Wiki Billing 10022, 76536 & 76942

[OliviaPrice]

A patient was seen by his primary care physician for a neck mass. The physician orders a full ultrasound with a possible FNA. Our department performs the full ultrasound which is abnormal and the FNA is performed with U/S guidance. The specimen is sent to the lab.

Can I bill the 76536, 76942 w/ mod -59, & 10022? Or should only the 76536 & 10022 be billed?

 

[mehentrup7@aol.com]

Billing 10022, 76536, & 76942

I would think (for Medicare) that code 10022 is the only code that will be allowed. The CPT-4 definition states with imaging.

 

[thomas7331]

I disagree with the post above, the 10022 description is for a FNA done with imaging guidance, but CPT does not state that the code includes the radiological service - in fact it refers you to the appropriate codes. Per NCCI, the U/S guidance code is not included in the FNA procedure 10022, so if the physician or facility you are billing for performed and documented imaging guidance, you should bill 76942. The other ultrasound is a separate service so should also be reported. Neither radiology code bundles to 10022 so no modifiers are necessary (except 26 or TC if you are billing only for physician or for technical).

 

[devine1]

Billing for Diagnostic Ultrasound with FNA with US Needle Placement

The patient was seen and examined in the office for a questionable seroma. U/S was performed and confirmed that their was a breast seroma.

Immediately following, the doctor performed an FNA with U/S needle localization.

We coded it as: 10022, 76942-59, 76641

they paid for 10022 and 76942 and denied the 76641 due to some three hour radiology rule?

Should this be appealed or is this denial correct?