Wednesday, December 28, 2016

CPT 76856, 76857 - Radiology pevic ultrasound procedure

Indications

Pelvic pain undiagnosed by standard exam;
Dysmenorrhea;
Menorrhagia;
Metrorrhagia;
Menometrorrhagia;
Postmenopausal bleeding;
Abnormal pelvic examination;
Further evaluation of abnormality found on other imaging studies; and
Cancer

76856 is a complete evaluation and must minimally include:

Female: description and measurements of the uterus and adnexal structures, measurement of the endometrium and bladder, and a description of any pelvic pathology.

Male: evaluation and measurement of the bladder, evaluation of the prostate and seminal vesicles and any pelvic pathology.

76857 is a limited study and typically focuses on one or more elements listed under 76856 and/or the reevaluation of one or more pelvic abnormalities.

Limitations

Post voiding residual bladder volume is not reimbursable by CPT codes 76856 and 76857. Measurement of post voiding residual should be billed using CPT code 51798.

The accuracy of ultrasonographic studies depends on the knowledge, skills and experience of the technologist and interpreter. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation of such for possible audit. Further, ultrasonographic studies must be either (1) performed by persons with appropriate training that have demonstrated minimum entry level competency by being credentialed by a nationally recognized credentialing organization in ultrasound technology (e.g., American Registry of Radiologic Technologists (ARRT) in sonography), (2) performed by or under the direct supervision of a physician, or (3) performed in facilities with laboratories accredited in ultrasonography.


CPT/HCPCS Codes


76856 Us exam pelvic complete
76857 Us exam pelvic limited



ICD-10 CODE DESCRIPTION

A18.14 Tuberculosis of prostate
A56.11 Chlamydial female pelvic inflammatory disease
C45.1 Mesothelioma of peritoneum
C48.0 - C48.8 - Opens in a new window Malignant neoplasm of retroperitoneum - Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C52 - C57.4 - Opens in a new window Malignant neoplasm of vagina - Malignant neoplasm of uterine adnexa, unspecified
C57.9 - C58 - Opens in a new window Malignant neoplasm of female genital organ, unspecified - Malignant neoplasm of placenta
C61 - C62.92 - Opens in a new window Malignant neoplasm of prostate - Malignant neoplasm of left testis, unspecified whether descended or undescended
C63.9 Malignant neoplasm of male genital organ, unspecified
C67.0 - C67.9 - Opens in a new window Malignant neoplasm of trigone of bladder - Malignant neoplasm of bladder, unspecified
C76.3 Malignant neoplasm of pelvis
D06.0 - D07.39 - Opens in a new window Carcinoma in situ of endocervix - Carcinoma in situ of other female genital organs
D25.0 - D27.9 - Opens in a new window Submucous leiomyoma of uterus - Benign neoplasm of unspecified ovary
D28.1 - D28.2 - Opens in a new window Benign neoplasm of vagina - Benign neoplasm of uterine tubes and ligaments
D28.9 - D29.9 - Opens in a new window Benign neoplasm of female genital organ, unspecified - Benign neoplasm of male genital organ, unspecified
D39.0 - D39.12 - Opens in a new window Neoplasm of uncertain behavior of uterus - Neoplasm of uncertain behavior of left ovary
D39.8 - D40.0 - Opens in a new window Neoplasm of uncertain behavior of other specified female genital organs - Neoplasm of uncertain behavior of prostate
D41.3 - D41.8 - Opens in a new window Neoplasm of uncertain behavior of urethra - Neoplasm of uncertain behavior of other specified urinary organs
D78.01 - D78.02 - Opens in a new window Intraoperative hemorrhage and hematoma of the spleen complicating a procedure on the spleen - Intraoperative hemorrhage and hematoma of the spleen complicating other procedure
D78.21 - D78.22 - Opens in a new window Postprocedural hemorrhage of the spleen following a procedure on the spleen - Postprocedural hemorrhage of the spleen following other procedure
E28.0 - E28.9 - Opens in a new window Estrogen excess - Ovarian dysfunction, unspecified
E36.01 - E36.02 - Opens in a new window Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating an endocrine system procedure - Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating other procedure
E89.40 - E89.41 - Opens in a new window Asymptomatic postprocedural ovarian failure - Symptomatic postprocedural ovarian failure
G97.31 - G97.32 - Opens in a new window Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure - Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure
G97.51 - G97.52 - Opens in a new window Postprocedural hemorrhage of a nervous system organ or structure following a nervous system procedure - Postprocedural hemorrhage of a nervous system organ or structure following other procedure
I72.3 Aneurysm of iliac artery
I72.9 Aneurysm of unspecified site
I80.211 - I80.219 - Opens in a new window Phlebitis and thrombophlebitis of right iliac vein - Phlebitis and thrombophlebitis of unspecified iliac vein
K35.2 - K37 - Opens in a new window Acute appendicitis with generalized peritonitis - Unspecified appendicitis
K50.00 - K50.919 - Opens in a new window Crohn's disease of small intestine without complications - Crohn's disease, unspecified, with unspecified complications
K57.20 Diverticulitis of large intestine with perforation and abscess without bleeding
K57.32 Diverticulitis of large intestine without perforation or abscess without bleeding
K57.40 Diverticulitis of both small and large intestine with perforation and abscess without bleeding
K57.52 Diverticulitis of both small and large intestine without perforation or abscess without bleeding
K57.80 Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding
K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
K66.1 - K66.8 - Opens in a new window Hemoperitoneum - Other specified disorders of peritoneum
K68.11 Postprocedural retroperitoneal abscess
K68.9 Other disorders of retroperitoneum
K91.61 - K91.62 - Opens in a new window Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive system procedure - Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure
K91.840 - K91.841 - Opens in a new window Postprocedural hemorrhage of a digestive system organ or structure following a digestive system procedure - Postprocedural hemorrhage of a digestive system organ or structure following other procedure
N13.9 Obstructive and reflux uropathy, unspecified
N21.0 Calculus in bladder
N31.0 - N33 - Opens in a new window Uninhibited neuropathic bladder, not elsewhere classified - Bladder disorders in diseases classified elsewhere
N36.44 Muscular disorders of urethra
N41.0 - N41.9 - Opens in a new window Acute prostatitis - Inflammatory disease of prostate, unspecified
N70.01 - N71.9 - Opens in a new window Acute salpingitis - Inflammatory disease of uterus, unspecified
N73.0 - N74 - Opens in a new window Acute parametritis and pelvic cellulitis - Female pelvic inflammatory disorders in diseases classified elsewhere
N80.0 - N80.9 - Opens in a new window Endometriosis of uterus - Endometriosis, unspecified
N82.8 Other female genital tract fistulae
N83.53 - N84.0 - Opens in a new window Torsion of ovary, ovarian pedicle and fallopian tube - Polyp of corpus uteri
N84.8 - N85.9 - Opens in a new window Polyp of other parts of female genital tract - Noninflammatory disorder of uterus, unspecified
N89.7 Hematocolpos
N91.0 - N94.0 - Opens in a new window Primary amenorrhea - Mittelschmerz
N94.4 - N94.89 - Opens in a new window Primary dysmenorrhea - Other specified conditions associated with female genital organs and menstrual cycle
N95.0 Postmenopausal bleeding
N98.1 Hyperstimulation of ovaries
N99.510 - N99.518 - Opens in a new window Cystostomy hemorrhage - Other cystostomy complication
N99.61 - N99.62 - Opens in a new window Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating a genitourinary system procedure - Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating other procedure
N99.820 - N99.83 - Opens in a new window Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure - Residual ovary syndrome
Q50.01 - Q56.4 - Opens in a new window Congenital absence of ovary, unilateral - Indeterminate sex, unspecified
Q64.0 Epispadias
Q64.11 Supravesical fissure of urinary bladder
Q64.5 - Q64.79 - Opens in a new window Congenital absence of bladder and urethra - Other congenital malformations of bladder and urethra
R10.0 - R10.9 - Opens in a new window Acute abdomen - Unspecified abdominal pain
R16.0 - R16.2 - Opens in a new window Hepatomegaly, not elsewhere classified - Hepatomegaly with splenomegaly, not elsewhere classified
R18.0 - R19.09 - Opens in a new window Malignant ascites - Other intra-abdominal and pelvic swelling, mass and lump
R19.30 - R19.37 - Opens in a new window Abdominal rigidity, unspecified site - Generalized abdominal rigidity
R19.8 Other specified symptoms and signs involving the digestive system and abdomen
R31.0 - R31.9 - Opens in a new window Gross hematuria - Hematuria, unspecified
T81.4XXA Infection following a procedure, initial encounter
T88.8XXA Other specified complications of surgical and medical care, not elsewhere classified, initial encounter
Z48.22 Encounter for aftercare following kidney transplant
Z85.40 - Z85.41 - Opens in a new window Personal history of malignant neoplasm of unspecified female genital organ - Personal history of malignant neoplasm of cervix uteri
Z85.44 Personal history of malignant neoplasm of other female genital organs
Z87.42 Personal history of other diseases of the female genital tract
Z87.59 Personal history of other complications of pregnancy, childbirth and the puerperium
Z94.0 Kidney transplant status

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