CPT code 76942: Ultrasonic guidance Needle Placement NonVascular

CPT code 76942 is an diagnostic ultrasonic guidance code for needle placement. This code is used mostly for the percutaneous procedures. Percutaneous surgeries are same day surgery procedure and minimal invasive procedures. These procedures are performed through the skin percutaneously. Hence, guidance is always required for the procedure cpt code. Like Procedure code 76942, there are the other type of guidance as well depending on the type of guidance is used. For fluoroscopic guidance, we have 77001, 77002 and 77003 CPT code and depending on the kind of the procedure, we will use the guidance code.

There are different guidance codes used for vascular and non-vascular procedures. CPT 76942 is used for diagnostic ultrasound guidance non-vascular procedures. For vascular procedure, we use CPT code 76937 hence it should not be confused with 76942 CPT code. Now, let us check how and when to use CPT code 76942 to avoid the error with this code.

Image courtesy:http://paragonsportsmedicine.com/procedures/ultrasound-scan-diagnostic-guidance/

Common mistakes with CPT code 76942

Read also: Common errors with ICD 10 codes

When to use Procedure/CPT code 76942 (Ultrasonic guidance for Needle placement)

The Ultrasound/ultrasonic guidance or any other guidance code cannot be used primary; it should have a primary main procedure code for which the guidance is used. For example, if an arthrocentesis procedure is done with the use of guidance then the arthrocentesis CPT code should be primary followed by the guidance code, like 20610 and 76942. Many of the CPT codes now include the guidance codes; hence, we should be careful while assigning the CPT codes. CPT 76942 is an ultrasonic guidance for needle placement for procedures like biopsy, injection, aspiration etc.hence it should be used only with these procedures. Therefore, all the biopsy, spinal injection, joint injection, aspiration procedures will use ultrasound guidance 76942. Also Fine needle aspirations are also done with the help of this guidance.

Also as per  CMS NCCI coding guidelines, “Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same or different patient encounter(s) on the same date of service are not separately reportable.  For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement…) when performed in the same anatomic region on the same date of service. 

Hence, either of the procedure should be reported when CPT code 76872 Ultrasound, transrectal; or CPT code 76942 Ultrasonic guidance for needle placement are performed, based on the documentation in the patient’s chart. A modifier should not be used to unbundle this coding scenario as it has been deemed inappropriate coding.

Reimbursement :Most medical insurance plans cover ultrasound studies when they are indicated as medically necessary. However, Medicare and private payers may have different requirements. Private insurance payment rules vary by payer and plan as regards which specialties can perform and receive reimbursement for ultrasound services. Ultrasound providers face risk of denied claims and even audits if they are not knowledgeable about coding and billing rules and payer guidelines.

The following from CPT Assistant defines what would NOT be billable: “…for those instances when ultrasound is utilized only to identify a vein, mark a skin entry point, and proceed with a non-guided puncture, it would not be appropriate to report code 76937 for ultrasound guidance.”

Use of  76942 CPT code for Bilateral exam

As per Medicare  NCCI Policy ManualCPT 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.

For Medicare you would therefore report only 1 unit of 76942, even though 2 lesions were biopsied.  Other payers, you need to check with them for multiple units of  units of 76942.  However, it would be better to use CPT code 76942 without 50 modifier, till their is clear coding guideline for use of multiple units.

For example, If a physician performs a lung biopsy with ultrasonic guidance in the morning and then again the physician perfroms a thyroid biopsy with ultrasound guidance in the evening in separate encounter. The CPT codes will be reported as below:

Morning: 47000, 76942

Evening: 60100, 76942-XU

Since the physician performs both biopsy in different encounter, you can billed the ultrasonic guidance for both with a XU modifier.

While coding for physicians the medical coders can append 26 modifier with CPT code 76942 for diagnostic ultrasound. The 70000 series codes are from radiology chapter and hence the ultrasonic/ultrasound guidance codes can be reported with 26 modifier.

               

Read also: Top common CPT code errors of Medical Coders

Use Ultrasonic Guidance CPT code 76942 only as Secondary code

Ultrasound guidance are used for performing percutaneous surgeries. Hence, most of the procedures like thoracentesis, breast biopsy, Myelogram, spinal epidural injection etc. needs the help of guidance for performing these procedures.  Hence, the primary code is always the surgery procedure code followed by the guidance code like 76942. Most of the major procedures have now bundled the guidance including the breast biopsy and spinal injection procedures, hence be careful while using the guidance codes.

There are a separate list of ultrasound procedure codes in radiology which are used as primary codes. 

Difference between Ultrasound guidance CPT code 76937 and 76942

In interventional radiology coding, we have two ultrasound guidance code for vascular and non-vascular procedures. For vascular procedures like central venous catheter placement, angioplasty, thrombectomy, AV fistula procedure the medical reports have to report procedure code 76937 as ultrasound guidance. Three important criteria should be met in documentation for coding guidance code 76937.

  • Patency of the blood vessel
  • Recording of images
  • Under ultrasound guidance documentation

For Non-vascular procedures like arthrogram, arthrocentesis, biopsy, etc the medical coders have to report CPT code 76942 as ultrasound guidance.

Do and Don’t about CPT code 76942

CPT code 76942 should be coded once per encounter

Do not use CPT code 76942 for vascular procedures; separate ultrasound guidance code 76937 is used for these procedures.

Do not use any modifiers like RT, LT, 59, 51 etc with CPT code 76942. Modifiers are not eligible with CPT code 79642.

Do not report 19281-19288 in conjunction with 19081-19086, 76942, 77002, 77021 for same lesion. Placement of breast localization device procedures inlcudes the mammographic guidance, stereotactic, MRI and ultrasound guidance.

Do not report 20600, 20604 in conjunction with 76942, 0489T, 0490T. Arthrocentesis CPT codes have separate code for with and without ultrasound guidance, hence CPT code 20600 will be reported for without ultrasonic guidance and CPT code 20604 will be reported for with ultrasonic guidance exam.

Do not report 49083 in conjunction with 76942, 77002, 77012, 77021. CPT code 49083 is reported for abdominal paracentesis exam which includes imaging guidance.

Do not report CPT code 20610, 20611 in conjunction with 27369, 76942

Do not report 45392 in conjunction with 45378, 45391, 76872, 76942, 76975. This colonoscopy exam includes the ultrasound guidance hence should not be reported separately.

Do not report 10030 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021. CPT code 10030 includes the ultrasound, fluoroscopic, CT and MRI imaging guidance, hence should not be reported separately.

Do not report 49407 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021. CPT code 49407 includes the ultrasound, fluoroscopic, CT and MRI imaging guidance, hence should not be reported separately.

Do not report 37760, 37761 in conjunction with 76937, 76942, 76998, 93971. CPT code 37760, 37761 includes the use of ultrasonic guidance, when performed.

Do not report 62321 in conjunction with 77003, 77012, 76942

Do not report 45342 in conjunction with 45330, 45341, 76872, 76942, 76975

Do not report 55874 in conjunction with 76942

Do not report 49406 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021

Do not report 49084 in conjunction with 76942, 77002, 77012, 77021

Do not report 32554-32557 in conjunction with 75989, 76942, 77002, 77012, 77021. Use Thoracentesis CPT code 32554 if the procedure is performed without imaging guidance. Use CPT code 32555 when imaging guidance is used during the procedure.

Do not report 62323 in conjunction with 77003, 77012, 76942

Do not report 10005, 10006 in conjunction with 76942

55 Thoughts to “CPT code 76942: Ultrasonic guidance Needle Placement NonVascular”

  1. Edward Allen Sharrer

    Can you combine CPT 76942 with an injection code of 20600?

    1. No, we have combination CPT code 20604, 20605 and 20611 for arthrocentesis with ultrasound guidance…which should be used when arthrocentesis procedure is done with ultrasound guidance 76942.

  2. […] ultrasound 76937 and fluoroscopic 77001-guidance support to perform this procedure. Do not report CPT code 76942 for Vascular procedures as ultrasound guidance. Code 76942 should be used only with non-vascular […]

  3. […] you can easily code the below sample medical coding report. In this report, a non-vascular ultrasound guidance (76942) is used for Cholecystostomy. But, Cholecystostomy exam includes the ultrasound guidance. Hence, the […]

  4. […] In this surgery, a circular opening is created on the lens surface (capsule). Sound waves (ultrasound) or laser is used to break the cataract into small pieces. The cataract and lens pieces are removed […]

  5. Saritha

    Hi iam taking cpc exam first attempt I got 66 % iam worried about my second attempt can plz suggest me how to clear cpc.and share any new practices questions and answers papers plz.

    1. Do not get worried…next time work hard more…I have shared few sample questions already on my website…attempt all questions of CPC exam…it is easy to clear this exam if you know the coding guidelines perfectly..!!

  6. […] and catheter placements.  All these codes include all the imaging guidance like fluoroscopy or ultrasound performed during these exams. Also all the radiological supervision and interpretation (S&I) […]

  7. How to utilize Time during AAPC CPC exam - Medical Coding Guide

    […] can check the options and easily get correct answer by ignoring non-vascular guidance CPT codes (76942,77002 &77003). So, if you are 100% confident avoid using codebooks which will save your lot of […]

  8. […] guidance separately with CPT code 37191, 37192 and 37193. These codes includes all the respective guidance like ultrasound or fluoroscopic done during these […]

  9. […] FNA. Fluoroscopy helps in guiding the correct advancement of needle to the area under examination. Ultrasound guidance CPT 76942 helps in insertion of an aspiration catheter needle through the accessory channel port of the […]

  10. Rajee Rajee

    IAM attended CPC exam 1st attempt I got 66% please share me some tips how to clear 2 nd attempt

    1. you need to work hard more on your weakness and learn some time management skills during exam. Try to attempt all the questions then only their is a possibility of clearing the CPC exam. Prepare nicely for surgery section which takes lot of time. Many tips I have already shared in my blog itself. All the best for your Second attempt.

  11. […] Read also: Common Mistakes of Surgery coders with CPT code 76942 […]

  12. […] This fluoroscopy guidance code is only made for vascular coding. If you remember we have different ultrasound guidance CPT code 76937 for vascular procedure, the same way we have to use CPT code 77001, as fluoroscopic guidance […]

  13. […] vascular and non-vascular percutaneous procedure. Cpt Code 76937 is used for vascular procedure and 76942 cpt code is used for non-vascular procedure like biopsy. This differences between vascular and non-vascular […]

  14. […] between CPT 32556 and 32557 is whether radiology guidance is used. If the documentation supports ultrasound, fluoroscopy, CT, or MRI used to gain visualization of the chest and guide the placement of the […]

  15. […] percutaneous procedures, you can learn first about coding imaging guidance codes 76942, 76937, 77001, 77002, 77003 […]

  16. […] procedures like  biopsy, joint injection, Fine needle aspiration etc. use of ultrasound guidance CPT code 76942 is used. While for coding vascular procedures like central venous catheter placement, CPT code […]

  17. […] use imaging guidance CPT code 76942, 77002, 77012, 77021 along with lymph node biopsy CPT […]

  18. Jacqueline Abat

    Hi..I think you have typo error on the last part of your article.79642 instead of 76942..(below Do and dont with Cpt76942)

  19. […] CPT codes which are very common in diagnostic radiology coding. We have already learnt about  ultrasound guidance CPT code  76492, which is used mainly for non-vascular procedure. Same way, we have a RS&I CPT code 75989, used […]

  20. […] with 20550, 20551, 20600, 20604, 20605, 20606, 20610, 20611, 20926, 36415, 36592, 76942, 77002, 77012, 77021, 86965, 0481T. Do not report 38220-38230 for bone marrow aspiration […]

  21. […] (S&I) and imaging guidance codes used along with above cpt codes are 74425, 74470, 76942, 77002, 77012 or 77021. When the findings are given with procedure performed we have to code the […]

  22. […] requires the use of secondary code. For example, if you are coding a thyroid biopsy along with an ultrasound (76942) or Fluoroscopic guidance (77002), you need to report two CPT codes, one for biopsy and the other […]

  23. […] the most commonly used code used for biopsy is Ultrasound guidance, CPT code 76942. One needs to always remember it should be coded only with non-vascular procedures in surgery […]

  24. […] procedure code includes the guidance, hence do not report CPT code 10030 in conjunction with 75989, 76942, 77002, 77003, 77012, […]

  25. In an asc setting, do you need to use modifier 26 with 76942 to indicate that the physician will bill for it?

    1. Yes…when you code for physician you have to give 26 modifier for guidance and S&I CPT codes

  26. Radhika

    Jitendra, Thanks for your prompt reply. My understanding was that a physician using our facility would submit his own hcfa1500 with the primary procedure code and then 76942 with modifier 26.
    Since our asc facility has a different npi and tax id, we would code using the primary code, and also 76942 with modifier TC.
    Is this accurate, or should the asc also add modifier 26 on its claim?

    1. If you are only billing for professional component then you can use 26 modifier with 76942 and if you are want to billing for technical component for the technical use of facility you can bill 76942 with TC Modifier. If the facility owns both professional & technical component then no need of any modifier with CPT code 76942

  27. […] there is procedure done along with imaging guidance like ultrasound guidance 76942 and abdominal paracentesis is also done with imaging guidance 49083, do use a 59 modifier with […]

  28. […] (19081-19086) – The mass is located with the use of imaging guidance (stereotactic imaging, ultrasound, or MRI) and a marker is placed; the patient receives general anesthesia or local anesthesia with […]

  29. […] fluoroscopy, CT, MRI etc. Earlier when we used to code breast biopsy was used to code along with ultrasound (76942), fluoroscopy (77002), MRI, CT (77012), stereotactic guidance. But, now new CPT codes for breast […]

  30. […] report CPT code 33016 in conjunction with ultrasound, fluoroscopic, CT or MRI image guidance codes (76942, 77002, […]

  31. […] biopsy is performed using ultrasound guidance we have to assign lung biopsy CPT code followed by Ultrasound guidance code 76942. These are minimal invasive procedures or percutaneous (through the skin) procedures. Whenever a […]

  32. […] within the skin overlying the right common femoral artery for local anesthesia. Under direct ultrasound guidance a micropuncture needle was advanced into the common femoral artery and a microwire advanced. The […]

  33. […] can check the options and easily get correct answer by ignoring non-vascular guidance CPT codes (76942,77002 &77003). So, if you are 100% confident avoid using codebooks which will save your lot of […]

  34. […] example, if a biopsy is done and there is ultrasound guidance is used and the option has 76942 and 76937. So, we know the vascular ultrasound 76937 is not used for biopsy, so finally the answer […]

  35. […] and should be coded only with non-vascular procedures. I have already share an article about the CPT code 76942 which will give more information about this CPT code. This code is used in biopsy like thyroid […]

  36. […] – Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when […]

  37. […] errors in coding wrong guidance code. While coding a vascular procedure I have used a non-vascular ultrasound guidance 76942 code instead of vascular ultrasound guidance CPT code 76937. This is very big error in medical […]

  38. […] examination of tissues, thyroid biopsy is performed. So, let use learn the guidelines to code CPT code for ultrasound guided biopsy of […]

  39. […] of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with […]

  40. […] necessary, report code 76942 for ultrasound guidance or 77021 for MRI guidance in addition to codes 62270 and […]

  41. […] about  breast biopsy, lung biopsy, thyroid biopsy, axillary lymph node biopsy. Here, also the CPT code 76942, 77002, 77012, 77021 should be used as imaging guidance with muscle biopsy. 20200 – Biopsy, […]

  42. […] shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar […]

  43. […]  Since all the diagnostic cardiac catheterization CPT codes does not include intravascular ultrasound, it should be reported separately while coding cardiac catheterization procedures. These procedures […]

  44. […] to ask questions, wished to proceed, and signed the written informed consent form. Using ultrasound guidance, a safe route of access was identified into the right pleural space. The site was then prepped and […]

  45. […] infiltration. Access to the lower pole collecting system of the left kidney is obtained utilizing ultrasound guidance an AccuStick system. Wire and catheter advanced into the collecting system of the left kidney […]

  46. […] with Current Procedural Terminology (CPT®) code 76978 for the contrast-enhanced ultrasound, CPT code 76942 for the ultrasound guidance of the liver biopsy, and code 47000 for the liver […]

  47. […] to report code 64640, Destruction by neurolytic agent; other peripheral nerve or branch, with code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), […]

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