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76942 performed bilaterally with injection

Renee Posted Wed 01st of August, 2012 18:42:01 PM

Code '76942' is used for ultrasonic guidance for needle placement with injection for Supartz, hyalgon, etc. Should it be billed with -50 modifier or LT/RT

SuperCoder Answered Wed 01st of August, 2012 19:21:42 PM

Units: Medicare lists a Medically Unlikely Edit (MUE) of 1 for 76942. That means if you report more than one unit of 76942 on a line for a single beneficiary on a single service date, you'll get a denial for that line item.

In relation to the Medicare physician fee schedule (MPFS), the modifier you're most likely to use with 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) is modifier 26 (Professional component).

Modifier 26 tells the payer you're reporting the physician's services. Those reporting only the technical component append modifier TC (Technical component). If you're reporting the global service (professional and technical combined), you should not append 26 or TC.

When appropriate, the MPFS allows use of the following modifiers if you send documentation supporting medical necessity:

Modifier 80, Assistant surgeon
Modifier 81, Minimum assistant surgeon
Modifier 82, Assistant surgeon (when qualified resident surgeon not available).

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