Three placements under one guidance service

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Outpatient diagnostic or treatment service; stated component and Medicare relationship

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Procedure record

Fictional adult undergoes three documented needle placements during one encounter. The same ultrasound guidance service, within the specific needle-guidance family addressed by NCCI G.3, is used. The exercise assumes that separate guidance reporting is otherwise supported by the complete primary procedure and its instructions.

Guidance work

The clinician documents the target locations, needle visualization and saved images required for the guidance. The placements occur in the same encounter. No later return or separate date is described, and the record does not establish three distinct guidance encounters.

Unit distinction

The procedural worksheet lists three placements and several images. These details document the work performed but do not define the Medicare unit for the guidance entry. The learner must keep primary-procedure units separate from the guidance-unit question.

Claim review

A draft assigns three guidance units, one per placement. Apply the encounter-based unit for the specific cited family without generalizing it to every imaging code. The exercise does not grant permission to add guidance when the primary entry already includes it.

Your coding worksheet

Confirm the stated separately reportable guidance assumption.
Identify the number of encounters.
Evaluate the three-unit proposal.
Keep guidance units separate from primary-procedure units.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The case expressly assumes the full primary-entry relationship permits this guidance service.
All three placements occur in one encounter.
NCCI G.3 uses the encounter as the unit for the specified guidance entries, not each placement or image.
The actual primary procedure must be reviewed separately; an encounter-unit rule does not override an inclusion.

Reference sections: G.3

Practice the linked chart questions