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lumbar epidural catheter with ultrasound

Paula Posted Tue 15th of April, 2014 18:28:57 PM

Is it feasible to use ultrasound rather than fluoroscopy to insert an lumbar epidural catheter for post operative pain?
If so, can the ultrasound be submitted to the carrier? Which codes?

SuperCoder Answered Wed 16th of April, 2014 09:52:39 AM

Medicare reimburses for ultrasound services when the services are within the scope of the provider’s license and are deemed medically necessary.

It is entirely upto the physician to choose which imaging services are required at that moment of time.

Site of Service - Ultrasound Services
In the office setting, a physician, who owns the equipment and performs the ultrasound guidance, may report the global/non-facility code and report the CPT code without any modifier.

Hospital Outpatient or Ambulatory Surgery Center (ASC)
If the site of service is a hospital or an ASC and the anesthesia provider is performing the ultrasound guidance, the –26 modifier (professional service only) should be appended to the CPT code for the imaging service.

Based on the Medicare Outpatient Prospective Payment System (OPPS), the technical component of image guidance procedures that are performed in the hospital outpatient department or in the ASC are considered a packaged service. This means that the payment to the facility for these services is included in the payment for the primary procedure.

Use of ultrasound guidance with continuous and single shot nerve blocks may be a covered benefit if such usage meets all requirements established by the particular payer. It is essential that each claim be coded appropriately and supported with adequate documentation in the medical record.Coverage by private payers varies by payer and by plan with respect to which medical specialties may perform ultrasound services. Some payers will reimburse ultrasound procedures to all specialties while other plans will limit ultrasound procedures to specific types of medical specialties. In addition, there are plans that require anesthesia providers to submit applications requesting these services be added to the list of services performed in their practice. It is important that you contact the payer prior to submitting claims to determine their requirements.

CPT 76942 and CPT +76937

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