Billing 76942, ultrasonic guidance for needle placement
When coding the CPT code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation, the provider needs to review coding guidelines to determine if this is procedure is separate and distinct from any other procedure performed at the same site on the same date of service.
- The intent of CPT code 76942 is to describe an ultrasound used to localize a mass or region to be biopsied with a needle, and to guide the needle into the mass or region.
- Support for using 76942 with an associated procedure/code must be clearly documented in the medical record as reasonable and necessary.
Refer to CMS NCCI edit guidelines
Although we are aware of the criteria outlined by the AUA and AMA, Priority Health follows the CMS NCCI Chapter 9 guidelines:
9. Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same or different patient encounter(s) on the same date of service are not separately reportable. For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in the same anatomic region on the same date of service. Physicians should not avoid these edits by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service.
Example: If a provider has a patient that needs to have a diagnostic ultrasound (CPT code 76872) with an ultrasound guided needle biopsy (CPT code 76942), these two codes should not be coded together if the ultrasound guided needle biopsy is performed at the same anatomical site as the diagnostic ultrasound.