1. Stephanie Harlan
   Posted 3 months ago #
   

   I rec'd a denial for code 76942 for the following reason:

   Per the AMA CPT guidelines in the Radiology Seciton, Diagnostic Ultrasound, it states that "Use of ultrasound, without a thorough evaluation of organ(s) or anatomic region, image documentation, and a final, written report, is not seperately reportable.

   We billed 99214, 76942 , 20610 and J1885. The doctor did not bill nor does his note describe he did a complete(76881) or limited(76882) ultrasound.

   So is my interpertation of this correct. Since the doctors documentation only states he used the ultrasound guidance for the injection and did not go into detail regarding a full exam of the knee prior to proceeding with the injection we cannot get paid for this charge?

2. Try Super
   Posted 3 months ago #
   

   I think you are right.
   But one question: What is the denial statement on EOB ?

3. Stephanie Harlan
   Posted 3 months ago #
   

   The stmts states "Per the AMA CPT guidelines in the Radiology Seciton, Diagnostic Ultrasound, it states that "Use of ultrasound, without a thorough evaluation of organ(s) or anatomic region, image documentation, and a final, written report, is not seperately reportable."

   The description for CPT 76942 Ultrasonic guidance for needle placement (eg biopsy, aspiration, injection, localizationdevice, imgaiging supervision and interpretation.

   The doctor did not need to do a limited or complete ultrasound, since his main purpose was just to guide the needle for the injection. I don't show this code is bundle either with any of the other codes.

4. SuperCoder
   Posted 3 months ago #
   

   The denial is absolutely logical. When you are using Ultrasound guided procedure and coding for Ultrasound guidance, if at the same time we are coding for Ultrasound of the same anatomical site, then details of all has to be documented to justify medical necessity for performing an Ultrasound along with US guided procedure.

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