Wiki Cpt 76942?

[AimeeA10]

Hi - I am looking for some guidance on how to bill the ultrasound guidance our physician uses with the pump refill. Below I have supplied sample documentation that we get from him. Would you use the code 76942 for this? Thanks in advance for any help!

DESCRIPTION OF ULTRASOUND GUIDED SYNCHROMED II INTRATHECAL INFUSION PUMP REFILL: The usual sterile prep was performed to the abdominal skin overlying the pump site. An attempt was then made to palpate the edges of the pump circumferentially in order to determine the location of the pump's center refill port. The 22-gauge non-coring needle was inserted through the skin overlying the refill port and the ultrasound transducer was placed juxtaposed to the needle entry site and manipulated until there was clear visualization of the refill port shaft.
Aspiration of the residual reservoir medication was confirmed by Doppler analysis demonstrating flow within the refill port shaft. Picture validation was produced at this point. The aspiration syringe was detached; the actual reservoir volume aspirated was reconciled with the telemetry reservoir volume anticipated and recorded. Utilizing sterile technique, the syringe containing the refill medication was connected to the refill needle tubing and the medication was slowly injected, with periodic aspiration, per protocol.
Ultrasound confirmation of Doppler flow within the refill port shaft was documented by picture evidence at the beginning of the injection process, again in the middle of the injection process, and finally at the end of the injection process. These pictures were saved for validation and future reference. Over pressurization was negative. The needle was removed and the site cleaned. A sterile adhesive bandage was then applied to the injection site.

 

[LisaAlonso23]

Use 76942 with a -26 modifier if the dr doesn't own the equipment.

 

[Amy Pritchett]

Since it seems that the physician read and interpreted the ultrasound as he was performing the procedure, I would code 76942 for global ( which includes the -26 and TC modifiers). If the physician does not own the equipment, then you would place the -26 modifier on the 76942.

Hope this helps!!

 

[dwaldman]

If the service was provided in a facility setting, modifier 26 would have to be appended to CPT 76942 regardless of the ownership of the equipment. This would apply to Medicare or carriers that follow a similar concept that in a facility setting the physician would not be able to be reimbursed for the global component.

I am only pointing this out because you stated the notes you get from the physician which sounded like they the services was being provided at alternative location then his office.