Forum - Questions & Answers

Aug 23rd, 2011 - kathys

-76 modifier use

Hello. We do varicose vein treatment in our office. For billing purposes, we are wondering what the correct modifier is for a certain procedure. For one procedure, Ultrasound Guided Sclerotherapy, we use 36471, 93971 and 76942. Quite often there are several of the 76942's performed in the same visit. What is the correct modifier to use for the multiple units of 76942? Would -76 be appropriate? Or is there a more appropriate modifier to use? If so, what would that be? From our research, it appears that -76 is the most appropriate to use.

Any information you can offer on this would be greatly appreciated!
Thank you in advance for your help.

Sincerely,

Kathy

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Aug 25th, 2011 - jschmutz   323 

re: -76 modifier use

CPT® codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, NOT number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.


CPT® ASSISTANT (CPT® Assistant April 2005, page 16):
American Medical Association:
From a CPT® coding perspective, code 76942 should be reported per distinct lesion that requires separate needle placement.


Medicare. To be in accordance with Medicare policy, code only one needle placement, according to the National Correct Coding Initiative (NCCI) guidelines. Also, remember this applies only to codes 76942, 77002, 77003, 77012, and 77021. Other guidance codes, such as mammographic (77032), stereotactic (77031), and catheter placement (75989) can be coded and modified with the -59 modifier as necessary for all payers.

Non-Medicare . For commercial insurance, consider applying modifier -59 or -76 if documentation supports the biopsy guidance procedures when reporting 76942, 77002, 77003, 77012, and 77021 for multiple lesions on the same encounter.

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