Wiki CPT code 76942-Our Endocrinologist

[NESmith]

Our Endocrinologist is doing a fine needle aspiration on two lesions (lt & rt) and a core needle bx with ultrasonic guidance. He is billing these procedures as 10022 with 76942,10022-59 with 76942-59, 60100 with 76942 and 60100-59 with 76942-59. I believe that it should be billed 10022, 10022-59, 60100-59, 60100-59 & 76942(only once). Medicare MUE states 1 unit, but he states that the way he is billing is correct. This is a commerical insurance payer but I don't think that this makes a difference. Please let me know what you think. Thanks

 

[AForeman]

in my opinion your doctor is right. you will want to bill for guidance for each of the codes as long as he dictated each aspiration and biopsy was done under ultrasonic guidance. the only thing i would change is the both of the 10022 require 59 mods and only 1 of the 60100 should not have any modifer. The 10022 are bundled into the 60100. i do code for this on a regular basis. i hope this helps.

 

[CatLaw]

I recently found this out myself...anytime they are performing more than one procedure, if ultrasound guidance is used on each, you will code guidance for all. For example, if they performed 3 procedures under ultrasound guidance, you would list 76942 three times. Some insurances will only pay up to three.

 

[mitchellde]

The 10022 is bundled into the 60100 meaning you cannot unbundle unless there is a separate site. So if you perform the bx after the aspirate of the same site then you can bill the bx only.
From the CCI intructions:
Correspondence Language Policy/Example Number 5.60000 - Sequential procedures
For example, if a fine needle aspiration of the thyroid (CPT code 10021 or 10022) is unsuccessful and is followed at the same patient encounter by a percutaneous core needle biopsy of the thyroid (CPT code 60100), only CPT code 60100 may be reported. Therefore, CPT code 10021 or 10022 is not separately reportable with CPT code 60100.
If you could always bypass the edit just with the 59 modifier then there would be no reason for the edit. You may bypass the edit only if there is a separate site involved, or separate time of the day. If it is a separate session the bx is performed in then you need a modifier other than the 59. so from what you have stated you should only have:
60100 50
76942
76942 59

 

[Kimberley]

Billing 10022 and 76942 multiple times

Would it be correct to bill 10022, 10022-59, 10022-59 and 76942 x 3 in the below scenario?

The left neck and ultrasound transducer were prepper with Hibiclens. One percent lidocain without epinephrine was used to anesthetize the skin entry site and deeper structures with a 25- gauge 1/5 inch needle. a lateral to medial approach was chosen. Subsequently, 3 separate ultrasound-guided passwer with 3 different 22-gauge needles were maede into the mass and speciments collected. Fixed and air-dried slides as well as a single container of washings were obtained.

Thanks

Kimberley Tober, CPC
Franklin, TN