Wiki Documentation for code 76942

[madgejones10]

We have been using 76942 (ultrasound for needle placement) combined with 20610 on almost all of our joint injections, and being paid (once per session).

I am concerned about the documentation requirements for use of this code.

We say... " ultrasound guidance was used for better localization of the needle for proper delivery of the medication" but I question whether this is enough.

Any thoughts? Also, Anthem BC/BS starting next year is requiring that anyone using ultra- sound be "credentialed in sonography."

Please weigh in on this!

 

[lewisbr]

76942

Hi at my orthopedic office we also use this code with 20610 and have been having problems with BCBS wantig out documentation before we get paid. Most of our physicians document how they went into the site from percutaneous approach, they document the size of the needle, how the patient tolerated the procedure before, during and after. And that has worked for getting payment when BCBS has requested additional documentation. You also mentioned that next year bcbs anthem is going to require credentials for use of the sono, do you have a link or website that I can go to, to get that information I would love to provide that to our practice administrator.

thanks

 

[nyyankees]

We have been using 76942 (ultrasound for needle placement) combined with 20610 on almost all of our joint injections, and being paid (once per session).

I am concerned about the documentation requirements for use of this code.

We say... " ultrasound guidance was used for better localization of the needle for proper delivery of the medication" but I question whether this is enough.

Any thoughts? Also, Anthem BC/BS starting next year is requiring that anyone using ultra- sound be "credentialed in sonography."

Please weigh in on this!

My thinking would be did the doc really need US guidance or are they using it because they bought the machine? I have docs that use US all the time and another doc down the hall that never does. So I think medical necessity comes in to play as the US pays well.