University Posted Wed 11th of December, 2013 12:46:22 PM
If a provider checks "ultrasound used" when performing an ultrasound guided peripheral nerve block, is this sufficient to append
76942 in addition to the nerve block code?
SuperCoder Answered Thu 12th of December, 2013 20:07:53 PM
Checking the box is not sufficient by itself.
CPT guidelines state, "Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized."
CPT® Assistant (March 2011) offers a bit of additional insight into the services required to support 76942. The code "requires that the ultrasound is used to guide the needle such as for a needle biopsy or fine needle aspiration (FNA) of an organ or body area. It is not required that the ultrasound guidance be used specifically for the insertion of the needle through the skin but the imaging must be used to guide the needle placement in order to report the code."
As an example of payer perspective, FCSO Medicare wants to see documentation of medical necessity (clinical value) for US guidance in the particular case. FCSO also states that 76942 is an S&I code, so it requires a physician's interpretation of the ultrasound. http://medicare.fcso.com/Coverage_News/256934.asp