Wiki question about CPT 76942

[brinktwins]

Is it true that you can bill CPT 76942 multiple times if the doctor has injected multiple sites under ultrasound guidance. Example: Total 6 trigger points. Doctor mentions in his note that the medication was divided up equally between each of the previously described sites. Needle was visualized under ultrasound during injectate insertion. Images saved. On the encounter doctor circles. CPT 20553, 76942 and the meds. How would you charge this claim out???

Thank you in advance for your help!

 

[MarcusM]

Code 76942 reports only the supervision and interpretation done by the physician during the ultrasonic guided needle placement.

For one or two muscles, see the CPT? code 20552.Report 20552 whenever the physician treats one or two muscles with injections, regardless of the number of shots. When the physician performs trigger points on three–plus muscles, you can report 20553.

http://www.bcbsms.com/com/bcbsms/ap...th=/policy/emed/Trigger_Point_Injections.html

 

[hgolfos]

My understanding of US guidance is that it can be reported per region, so it depends where the trigger points are. For example, if your doc is injecting the trapezius muscles and the gluteus muscles you could bill the 76942 twice because they are in different body regions. I would suggest appending a 76 mod to the second instance of the code.

Conversely, if the TPs were in the same region, such as a trapezius and a sternocleidomastoid or posterior cervical, you should only report the code once.

Documentation should include a report describing the visualization and a permanently recorded image.

 

[ollielooya]

For MCR you can only report the service once per day per DOS. It does not make any difference where or how many. The NCCI guidelines is plain on this. I've been studying this for our provider who also injects multiple sites. He bills out one per the MUE's. A while ago there was talk about a modifier "GD" that would override the edits, depending on documentation/criteria, but our MAC doesn't accept it. Other carriers that do not follow MCR guidelines might accept multiple units.

For MCR, you probably could appeal their denials for multiple units thru the redetermination and subsequent processes, and that will keep you busy for sure! And then I'm not sure by doing so on a regular basis might put the practice on the radar....

Hope others comment. Would like to see some discussion on that elusive GD modifier that for some reason stays hidden....

 

[healing13]

interesting discussion. we have always been told it can only be billed one time per day regardless of how many sites were treated.

The GD modifier states:-GD Units of service exceeds medically unlikely edit value and represents reasonable and necessary services.

CMS states:
CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, NOT number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.

It still seems like it can only be submitted one time per day period. So the question is, when can you use this modifier appropriately? And how much documentation will you need to submit to support it's use?

 

[ollielooya]

well, if your MCR contractor doesn't accept this modifier, it really doesn't make any difference. NGS doesn't. Would like to know if there are any contractors that do? That was the whole purpose of creating it----to over-ride the edits with proper criteria and documentation. I'm still wondering what would happen if the denia for multiplesl could be overturned after channeling thru the appeal processes. Has anyone who is reading this had success in doing so?