Health Information Management

Q&A: Can we bill needle placement for multiple sites per encounter?

APCs Insider, November 7, 2014

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Q: Is it appropriate to bill CPT® code 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) with a modifier for two different sites (e.g., fine needle aspiration of thyroid and needle biopsy of parotid)? This code has an MUE edit with a maximum of one unit with “appropriate modifiers considered,” per our claims scrubber.
 
A: According to the NCCI Manual, Chapter 9, this code can only be billed once per encounter no matter the number of sites. A modifier would be appropriate if the patient had one needle placement in the morning and another during a separate encounter later in the day (which isn’t usual):
 
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.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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