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Post Op Pain Reimbursement – Payment for 76942 (x2) when billed with 64447 & 64448

I have billed Medicare (Novitas) for CPT 64447 WITH 76942 (Ultra Sound Guidance) and CPT 64448 WITH 76942 for POST OP pain after a Total Knee Replacement.
Modifier 26 is added to each CPT 76942 item listed separately on each line.

98% of the time, both 76942 codes are denied; 1 with denial code CO-151 (..excessive amt/frequency of services not supported) and the other with denial code OA-18 (duplicate services).
They are then submitted for reconsideration with the result being that only 1 pays and the other denies as a duplicate.
2 images are submitted for the 2 sites, however, the provider does his dictation for both procedures on the same procedure note.

I am looking for advice on how to get the 76942 codes to pay for both without having to appeal or suggestions for documentation to submit for successful appeal for both USG’s.

Question: What is the correct way to bill for TWO CPT codes 76942 (Ultra Sound Guidance) with 64447 (Adductor canal single shot injection for a pain block) and
64448 (Adductor canal continuous catheter pain block) when performed on a single patient?

Question: Do additional modifiers need to be submitted along with the modifier 26?

Thank you for your assistance.

Medical Billing and Coding Forum

76942- Pain Specialist Group

Good Afternoon All –

I cannot wrap my head around the appropriate way of billing 76942 along with cpt codes 20552 + 20553.

We are doing an 20552/20553 injection in place of service 11. We have been receiving denials on 76942 from BCBS, Medicare, etc…

According to the cpt code book, 76942 can be reported with 20552/20553.

Are there any specific guidelines to 76942 and 20552/20553? Does it require medical necessity or a modifier on 76942?

Medical Billing and Coding Forum

76942 with regional anesthesia (not post-op pain block).

When the only anesthesia for a procedure is regional so it is being billed with an ASA code (such as 01810), is 76942 supposed to be billed for the ultrasound guidance? I know 76942 is billed with nerve block codes (644xx) for post-op pain management, but what about with an ASA code? I’ve never run across this until recently and can’t find anything to say if it’s correct or not. It seems like the ultrasound might be included but I can’t find anything that says so.

Medical Billing and Coding Forum

76942 with regional anesthesia (not post-op pain block).

When the only anesthesia for a procedure is regional so it is being billed with an ASA code (such as 01810), is 76942 supposed to be billed for the ultrasound guidance? I know 76942 is billed with nerve block codes (644xx) for post-op pain management, but what about with an ASA code? I’ve never run across this until recently and can’t find anything to say if it’s correct or not. It seems like the ultrasound might be included but I can’t find anything that says so.

Thanks

Medical Billing and Coding Forum

99214 with 76942

Physician is billing for 99214-25, 20553 and 76942. When I run this through the AAPC scrubber it states "Disallowed CPT code. 76942 cannot be reported with 99214, per CPT coding concepts". However, when I check the AAPC website and the Medicare NCCI edits, neither of them have an edit stating that 99214-25 and 76942 can’t be billed together. Any help with this would be appreciated. Thank you!!

Medical Billing and Coding Forum