Tuesday, August 9, 2016

ULTRASOUND CPT codes list- Definition and place Guides

Ultrasound CPT Code                  Description


76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation


76802  Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)


76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation

76810  Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

76812  Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)


76813 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation

76814  Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure)

76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position, and/or qualitative amniotic fluid volume), one or more fetuses

76816 Ultrasound, pregnant uterus, real time with image documentation, follow up (e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), trans abdominal approach per fetus.

76817  Ultrasound, pregnant uterus, real time with image documentation, transvaginal; for non-obstetrical transvaginal ultrasound use 76830; If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 in addition to appropriate transabdominal exam code.


DIAGNOSTIC ULTRASOUND

All diagnostic ultrasound examinations require permanently recorded images with measurements, when such measurements are clinically indicated. For those codes whose sole diagnostic goal is a biometric measure (ie, 76514, 76516, and 76519), permanently recorded images are not required. A final, written report should be issued for inclusion in the patient’s medical record. The prescription form for the intraocular lens satisfies the written report requirement for 76519.

For those anatomic regions that have “complete’’ and “limited’’ ultrasound codes, note the elements that comprise a ’’complete’’ exam. The report should contain a description of these elements or the reason that an element could not be visualized (eg, obscured by bowel gas, surgically absent).

If less than the required elements for a “complete’’ exam are reported (eg, limited number of organs or limited portion of region evaluated), the “limited’’ code for that anatomic region should be used once per patient exam session. A “limited’’ exam of an anatomic region should not be reported for the same exam session as a “complete’’ exam of that same region.

Evaluation of vascular structures using both color and spectral Doppler is separately reportable. To report, see noninvasive vascular diagnostic studies (93875-93990). However, color Doppler alone, when performed for anatomic structure identification in conjunction with a real-time ultrasound examination, is not reported separately.

Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized.

Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.


DEFINITIONS:

A MODE: Implies a one-dimensional ultrasonic measurement procedure.

M MODE: Implies a one-dimensional ultrasonic measurement procedure with movement of the trace to record amplitude and velocity of moving echo-producing structures.

B SCAN: Implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display.

REAL-TIME SCAN: Implies a two-dimensional ultrasonic scanning procedure with display of both two-dimensional structure and motion with time.



HEAD AND NECK

76506 Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including A-mode encephalography as secondary component where indicated

76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter

76511 quantitative A-scan only

76512 B-scan (with or without superimposed non-quantitative A-scan)

76513 anterior segment ultrasound immersion (water bath) B-scan or high resolution biomicroscopy

76514 corneal pachymetry, unilateral or bilateral (determination of corneal thickness)

76516 Ophthalmic biometry by ultrasound echography, A-scan;

76519 with intraocular lens power calculation

76529 Ophthalmic ultrasonic foreign body localization

76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation


CHEST

76604 Ultrasound, chest, (includes mediastinum) real time with image documentation

76641 Ultrasound, breast, unilateral, real time with image documentation  including axilla when performed; complete

76642 limited


ABDOMEN AND RETROPERITONEUM

Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation and final, written report, is not separately reportable.

76700 Ultrasound, abdominal, real time with image documentation; complete

76705 limited (eg, single organ, quadrant, follow-up)

76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete

76775 limited

76776 Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation
(Do not report 76776 in conjunction with 93975, 93976)


SPINAL CANAL

76800 Ultrasound, spinal canal and contents


PELVIS
OBSTETRICAL

Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation Codes 76805 and 76810 include determination of number of fetuses and amniotic/chorionic sacs, measurements appropriate for gestational age (> or =14 weeks 0 days), survey of intracranial/spinal/abdominal anatomy, 4 chambered heart, umbilical cord insertion site, placenta location and amniotic fluid assessment and, when visible, examination of maternal adnexa.

Codes 76811 and 76812 include all elements of codes 76805 and 76810 plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated.

Patient record should document the results of the evaluation of each element described above or the reason for non-visualization.

Code 76815 represents a focused "quick look" exam limited to the assessment of one or more of the elements listed in code 76815.

Code 76816 describes an examination designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously demonstrated on ultrasound, and should be coded once regardless of the number of fetus. (Bill on one line indicating the number of fetus in the units field)

Code 76817 describes a transvaginal obstetric ultrasound performed separately or in addition to one of the transabdominal examinations described above. For transvaginal examinations performed for non-obstetrical purposes, use code 76830.

Reimbursement amounts for the Medicaid Obstetrical and Maternal Services Program (MOMS) are noted in the Fee Schedule under column ‘FEE MOMS’. For information on the MOMS Program, see Policy Section.


76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester
76802 each additional gestation

(List separately in addition to primary procedure)

(Use 76802 in conjunction with 76801)

76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach (complete fetal and maternal evaluation); single or first gestation

76810 each additional gestation

(List separately in addition to primary procedure)

(Use 76810 in conjunction with 76805)

76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach (complete fetal and maternal evaluation); single or first gestation

76812 each additional gestation

(List separately in addition to primary procedure)

(Use 76812 in conjunction with 76811)

76813 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement,
transabdominal or transvaginal approach; single or first gestation

76814 each additional gestation

(List separately in addition to primary procedure)

76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses

(Use 76815 only once per exam and not per element)

(Use ONLY code 76815 to report ultrasound services provided in conjunction with procedure codes 59812-59857. Procedure code 76815 should be billed regardless of the approach used to perform the ultrasound procedure (eg, transvaginal))

76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus

76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal

(If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 in addition to appropriate transabdominal exam code)

76818 Fetal biophysical profile; with non-stress testing

76819 without non-stress testing

76820 Doppler velocimetry, fetal; umbilical artery

(Billable with a diagnosis of polyhydramnios, oligohydramnios, placental transfusion syndromes or poor fetal growth)

76821 middle cerebral artery

(Billable with a diagnosis of rhesus isoimmunization, placental transfusion syndromes or viral diseases complicating pregnancy (e.g. parvovirus B-19 infection))

76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M mode recording;

76826 follow-up or repeat study

76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete

76828 follow-up or repeat study


NON OBSTETRICAL

76830 Ultrasound, transvaginal
(If transvaginal examination is done in addition to transabdominal non-obstetrical ultrasound exam, use 76830 in addition to appropriate transabdominal exam code)

76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed

76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete

76857 limited or follow-up (eg, for follicles)


GENITALIA

76870 Ultrasound, scrotum and contents

76872 Ultrasound, transrectal;

76873 prostate volume study for brachytherapy treatment planning (separate procedure)


EXTREMITIES

76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete

76882 limited, anatomic specific

76885 Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation)

76886 limited, static (not requiring physician or other qualified health care professional manipulation)


VASCULAR STUDIES

(For vascular studies, see 93875-93990)


ULTRASONIC GUIDANCE PROCEDURES

76930 Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation

76932 Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation

76936 Ultrasound guided compression repair of arterial pseudo-aneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)

76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to primary procedure) (Do not use 76937 in conjunction with 76942)

76940 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation (Do not report 76940 in conjunction with 76998)

76941 Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation

76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
(Do not report 76942 in conjunction with 43232, 43237, 43242, 45341, 45342 or 76975)

76945 Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation

76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation

76965 Ultrasonic guidance for interstitial radioelement application



OTHER PROCEDURES

76975 Gastrointestinal endoscopic ultrasound, supervision and interpretation (Do not report 76975 in conjunction with 43231, 43232, 43237, 43238, 43242, 43259, 45341, 45342, or 76942)

76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method

76998 Ultrasonic guidance, intraoperative  (Do not report 76998 in conjunction with 47370-47382)

76999 Unlisted ultrasound procedure (eg, diagnostic, interventional)



Payment by Specialty & Accreditation/Certification Requirements

Specialists will be reimbursed for radiology services rendered in the office, outpatient or home setting. Services are payable to participating physicians based on their specialty. In addition, certain ultrasounds may not be reimbursed unless the providers hold a particular accreditation.

a. Reproductive Endocrinologists may perform the following ultrasound CPT codes; precertification for the fourth and subsequent procedures per Member per pregnancy is required:

** 76815, 76816, 76817

*In addition to the codes listed above a Reproductive Endocrinologist, with an AIUM/ACR accreditation may perform the following studies; precertification for the fourth and subsequent procedure per Member per pregnancy is required:

** 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76818, 76819, 76820, 76821, 76825, 76826, 76827, 76828.


b. Obstetricians/Gynecologists may perform the following ultrasound CPT codes; precertification for the fourth and subsequent procedure per Member per pregnancy is required:

** 76815, 76816, 76817

*In addition to the codes listed above an Obstetrician/Gynecologist, with an AIUM or ACR accreditation may perform the following studies; precertification for the fourth and subsequent procedure per Member per pregnancy is required:

** 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76818, 76819, 76820, 76821, 76825, 76826, 76827, 76828



c. Maternal Fetal Medicine and Perinatal Neonatal Medicine specialists may perform the following ultrasound CPT codes;

precertification for the fourth and subsequent procedure per Member per pregnancy is required:

** 76815, 76816, 76817

*In addition to the codes listed above a Maternal Fetal Medicine and Perinatal Neonatal Medicine specialist, with an AIUM or ACR accreditation may perform the following studies, precertification for the fourth and subsequent procedure per Member per pregnancy is required:

** 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76818, 76819, 76820, 76821, 76825, 76826, 76827, 76828




d. Board Certified Pediatric Cardiologists with the American Board of Pediatrics and Cardiology Laboratories accredited by the Intersocietal Accreditation Commission for Echocardiography may perform the following ultrasound CPT codes;

precertification for the fourth and subsequent procedure per Member per pregnancy is required:



Documentation Requirements

All diagnostic ultrasound examinations, including those when ultrasound is used to guide a procedure, require that permanently recorded images be maintained in the patient record. The images can be kept in the patient record or some other archive - they do not need to be submitted with the claim. Images can be stored as printed images, on a tape or electronic medium. Documentation of the study must be available to the insurer upon request. A written report of all ultrasound studies should be maintained in the patient's record. In the case of ultrasound guidance, the written report may be filed as a separate item in the patient’s record or it may be included within the report of the procedure for which the guidance is utilized.

Third Party Insurance Payment Policies Private insurance payment rules vary by payer and plan with respect to which specialties may receive reimbursement for ultrasound services. Some payers will reimburse providers of any specialty for ultrasound services while  others may restrict imaging procedures to specific specialties or providers only. Some insurers require physicians to submit applications requesting ultrasound be  added to their list of services performed in their practice.

Contact your private payers before submitting claims to determine their requirements and request that they add ultrasound to your list of services.

Generally Medicare will reimburse providers for medically necessary ultrasound services, provided the services are within the scope of the physician’s license. Some Medicare Contractors require that the physician who performs and/or interprets some types of ultrasound examinations be capable of demonstrating relevant, documented training through recent residency training or post-graduate CME and experience. Contact your Medicare Part B Contractor for details. Also we recommend checking for any local coverage determinations for the service(s) you intend to provide.

Some Medicare Contractors require that the physician who performs and/or interprets certain types of ultrasound examinations be capable of demonstrating relevant, documented training through recent residency training or post-graduate CME and experience.

Site of Service Payment Rules

In the office setting, a physician who owns the equipment and performs the service him or herself or through an employed or contracted sonographer, may bill the global/non-facility fee, and report the CPT1 code without any modifier.

If the site of service is a facility, hospital (inpatient, outpatient or emergency department) or Ambulatory Surgery Center (ASC) physicians must append the -26 modifier, indicating the professional service only was provided, to the CPT code for the imaging service. Payers will not reimburse physicians for the technical component in these settings.

In the above settings, the facility reports charges for the technical component for diagnostic ultrasound services.

In the hospital and ASC sites of service, under the Medicare Outpatient Prospective Payment System (OPPS), the technical component of image guidance procedures and the "add-on" codes for Doppler echocardiography are listed as packaged services. When these services are provided in the outpatient department or ASC, the payment for the image guidance is included in the reimbursement for the underlying procedure. Hospitals are required to submit CPT codes for packaged services. ASC's do not report CPT codes for packaged services. ASC's incorporate the cost of packaged services into the charge for the nerve block procedure.

Code Selection

Ultrasound services performed with hand-carried ultrasound systems are reported using the same ultrasound codes that are submitted for studies performed with cart-based ultrasound systems so long as the usual requirements are met. All ultrasound examinations must meet the requirements of medical necessity as set forth by the payer, must meet the requirements of completeness for the code that is chosen, and must be documented in the patient's record, regardless of the type of ultrasound equipment that is used.

• For ultrasound guidance of nerve block procedures, the recommended CPT code is 76942 - Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation.

Report CPT code 76942 in addition to the code for the nerve block itself Medicare Correct Coding Initiative (CCI) edits do not, at present, bundle the nerve block and ultrasound guidance of the nerve block specific to the procedures listed in this guide. It is recommended to check with each private payer regarding their policies on this service. In addition CPT has in recent years changed specific procedure codes to reflect to requirement of image guidance for several types of injections commonly performed by pain specialists. It is recommended to review CPT code descriptions carefully and adhere to the correct coding conventions

• Under the National Correct Coding Initiative, NCCI, which sets CMS payment policy as well as many private payers, one unit of service is allowed for CPT code 76942 in a single patient encounter regardless of the number of needle placements performed. Per NCCI, “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.

1 comment:

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