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55700 with 76872 and 76942

Teresa Posted Tue 14th of October, 2014 12:06:48 PM

I am wondering what the physician needs to do in order to be reimbursed for all three of these codes? More specifically what does he need to say in his note?

Thank you

SuperCoder Answered Wed 15th of October, 2014 05:42:24 AM

Transrectal ultrasound for prostatic evaluation has two codes depending on whether the ultrasound is diagnostic or for guidance during a procedure. If the provider performs a diagnostic ultrasound, use 76872 (echography, transrectal). If ultrasound guidance is used for a prostate biopsy, use 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the guidance and 55700 (biopsy, prostate; needle or punch, single or multiple, any approach) for the biopsy.

However, payers have different limitations on ultrasound codes being used together.

-Some payers will cover both ultrasounds on the same day if the first (76872) is clearly diagnostic; others will only cover the needle guidance (76942).

-Using a different diagnosis code for the transrectal ultrasound than the codes used for the biopsies may also help obtain full reimbursement.

You may try both the ways. However, as always the bottom line here is to check with your payer.

Thanks !!

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