The healthcare industry is striving towards the accuracy of medical procedures and treatments. Ultrasound-guided procedures are also a vital component of modern medicine. How? The technique is precise, accurate, and less intrusive for identifying and treating various musculoskeletal and vascular problems.
However, this blog covers the billing of this procedure. CPT code 76942 is used to represent an ultrasound-guided procedure in medical billing. We will discuss the correct uses of this code, including its billing strategies. So, if you are wondering how you will submit clean claims for CPT code 76942, keep reading!
CPT Code 76942 – Description
What does this code represent? Let’s start with the basic description of CPT code 76942. This code reports an ultrasonic guidance procedure (ultrasonography) required during injections or biopsies. More specifically, the procedure provides ultrasonic imaging that the healthcare professional uses to accurately insert a needle at the right point within the body.
What happens during the procedure? The radiologist uses sound waves at frequencies beyond 20 kHz to visualize internal structures. The targeted area reflects sound waves at varying rates as they travel through the human body. These waves that bounce back are then recorded and turned into pictures. A physician then analyzes these images through ultrasonography and places the needle within the body into the tissue that is supposed to be biopsied without harming the surrounding tissues.
This procedure is used to diagnose abnormalities, such as cancers or infections, treat fluid collections, and administer precise injections.
Scenarios Where CPT Code 76942 is Applicable
Now that we are clear about the general description of this code, let’s move on to some practical applications. The following scenarios will explain the practical uses of CPT code 76942.
Bone Marrow Aspiration
Suppose a 25-year-old girl who has been anemic since her childhood comes to a physician’s clinic. She tells the physician that after her recovery from viral fever, she is feeling fatigued even after resting well, her skin color is still pale, and she usually finds bruises on her body. The physician recommends a bone marrow aspiration to diagnose aplastic anemia. The radiologist performs ultrasonography to insert the needle in the hip bone before the procedure. Hence, he can use the CPT code 76942 to bill for his services.
Prostate Ultrasound and Biopsy
Suppose a 30-year-old man visits his family physician due to pain, burning, and bleeding while urinating. Additionally, he faces severe pain in the lower back and hip. To examine his prostate and diagnose any conditions, the physician wants to collect a tissue sample of the prostate gland (biopsy). However, before starting the process, the radiologist performs ultrasonography to help the physician visualize the prostate and collect a specimen from the targeted area. The radiologist can bill this service separately using CPT code 76942.
Fine-Needle Aspiration (FNA)
Let’s say that a 45-year-old woman has a noticeable bulge surrounding her breast. The physician recommends an FNA biopsy to determine whether the mass is solid or filled with fluid. Before carrying out a biopsy, the radiologist performs an ultrasound to insert the needle into the targeted area without hurting the surrounding tissues. To bill this ultrasonic guidance, the radiologist can use CPT code 76942.
Applicable Modifiers for CPT Code 76942
If you are performing extra services that are not included in the code description, you must mention them through applicable modifiers. These are some modifiers that you may apply with CPT code 76942.
Modifier TC
You may apply this modifier if you are a facility and billing only the technical components of the ultrasonic guidance, like equipment and technical staff.
Modifier 26
You can apply this modifier with CPT code 76942 when a physician at your practice performs the professional portion of the service, e.g, interpretation and reporting.
Modifier LT
Use modifier LT to indicate that the needle insertion with ultrasonic guidance was carried out on the left side of the body.
Modifier RT
In contrast, modifier RT is used to indicate procedures carried out on the right side of the body.
CPT Code 76942 – Billing & Reimbursement Guidelines
You can read specific billing guidelines for the CPT code 76942, as follows.
Append the Correct Modifier
It is important to use the correct modifier when needed. Some physicians confuse CPT code 76942 with a bilateral procedure. However, it is inappropriate to use modifier 50 with this code. A single unit of CPT code 76942 and the relevant laterality modifier, if applicable, should be reported for each bilateral procedure requiring ultrasound guidance.
Attach Supporting Documentation
Documentation plays a vital role in the reimbursement of services. If there is any slight error in your documentation, there is a high chance that the payer will deny your claims. However, each code has its own particular documentation requirements. It is crucial to record the specifics of the procedure as well as the medical necessity for ultrasonography guidance when reporting CPT code 76942. Your documents must comprise:
- Details regarding the anatomical location
- The treatment type
- Any noteworthy findings or problems
This information may support the use of this code. Moreover, appropriate compensation requires thorough and accurate documentation.
Payer Specific Guidelines
You must read and confirm with the payer’s guidelines before submitting claims. Why? Because some payers say that this code should be billed with the primary code and reimbursed with the payment of the primary procedure. Whereas, some believe that this code is standalone and should be billed separately. Hence, we advise you to cross-check with the payer’s guidelines before submitting claims to them.
Conclusion
We are confident that now you are much clearer about CPT code 76942. However, to conclude, this code represents an ultrasound-guided procedure to help the physician with correct needle placement. We have discussed some scenarios for the appropriate use of this code and its applicable modifiers. Note that accurate documentation and coding are important when it comes to ultrasonography-guided treatments.
If you are still confused about the use of CPT code 76942, you can acquire professional radiology billing services. Experts providing these services can address all the reimbursement problems and prevent coding errors that can result in potential claim denials or reduced reimbursements. Remember, it is crucial to code these procedures accurately.
