Health Information Management

Q&A: How do we resolve edits for needle placements?

APCs Insider, October 25, 2013

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Q: Some of our patients have multiple biopsies or aspirations during a procedure. The physician typically uses either ultrasound (US) or computed tomography (CT) guidance. We have been reporting the guidance based on the number of needles that are guided during the procedure. We are now hitting an edit and are not sure what to do with this. We have tried modifiers and single line items and nothing is resolving the edit. Payment is not impacted as these are status indicator “N” (items and services packaged into APC rates) under the OPPS. 

A: The CPT® codes for US guidance (76942) and CT guidance (77012) are defined by the modality and “for needle placement.” These codes are reportable when the physician uses and documents the guidance, but only one unit can be reported, not one unit per needle inserted. The National Correct Coding Initiative (NCCI) Manual, chapter 9, notes:

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.

Even though the status indicator for all of these codes is “N” under the OPPS—meaning always packaged— you must report the units correctly. In this instance, a unit of one is the maximum for any encounter/session.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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