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76942 and 76536

Venkataraman Posted Thu 08th of January, 2015 17:38:16 PM

Can you please confirm that following billing is correct?

Our practice/physician performs USFNA (ultrasound guided fine needle aspiration) procedures at an imaging center where they provide the equipment (ultrasound), technician and image storage in their PACS. Assuming a USFNA of the thyroid was performed, would the following be the correct billing procedure:

Imaging Center:
76536 – Global
76942 – TC

Our Practice/physician:
76942 – 26
10022 – Global

Thank you

SuperCoder Answered Fri 09th of January, 2015 00:11:12 AM

You can't bill code 76536 for Imaging centre since the provider is not performing any diagnostic ultrasound of thyroid.

The provider is performing ultrasound guided FNA of thyroid for which the most appropriate code is 10022. However, code 10022 is not eligible for PC/TC split.

Therefore, the provider should bill code 10022 globally and pay the imaging centre their part basis their mutual agreement.

Both can bill 76942 with their respective professional and technical component modifier.

Thanks !!

Venkataraman Posted Fri 09th of January, 2015 10:57:17 AM

Thank you for your response. A diagnostic scan of the neck is done prior to the usfna procedure on the same date of service. This is performed by the technician at the imaging center and stored within their PACS system. Shouldn't they bill 76536?

SuperCoder Answered Mon 12th of January, 2015 03:14:10 AM

Yes, in that scenario you may bill code 76536. Thanks !!

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