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Reader Question: On Thyroid Biopsy Day, Bill Both 76536 and 76942

Question: A carrier paid us for 10022, 76942 and 76536. But now the carrier is demanding a refund for 76536 because it says it bundles this code with 76942. Is it appropriate to bill for all three codes if the medical report shows a thyroid sonogram and an ultrasound-guided fine needle aspiration (FNA) for thyroid biopsy?

Arkansas Subscriber

Answer: Because the National Correct Coding Initiative does not bundle any of the codes on your claim, your carrier seems to have inappropriately bundled the codes together. The endocrinologist may have performed the ultrasound of the soft tissues of the head and neck (76536, Ultrasound, soft tissues of head and neck [e.g., thyroid, parathyroid, parotid], B-scan and/or real time with image documentation) for diagnostic purposes to establish the need for the FNA (10022, Fine needle aspiration; with imaging guidance) with ultrasonic guidance (76942, Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), so it is entirely appropriate that you bill for all these services on the same day.

Unless otherwise stated in the ultrasound code descriptors, the codes for imaging guidance include the imaging guidance only; they do not include a full ultrasound examination of the area. If the physician performs a separate radiologic exam of the area, which appears to be the case in your situation, you should separately report the imaging guidance and the specific radiologic exam. You should appeal your carrier's bundling decision and include information in your appeal that proves that the NCCI does not bundle these codes into one another.

-- The answers to You Be The Coder and the Reader Questions were provided and/or reviewed by Anita M. Carr, CPC, business office manager and assistant practice manager at Endocrine and Diabetes Associates in Louisville, Ky.; Anthony Azzi, MD, a clinical endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C.; and Judy Richardson, MSA, RN, CCS-P, senior consultant with Hill & Associates in Wilmington, N.C.