ED Coding and Reimbursement Alert

Question: Can we get paid for coding and billing for ultrasound services?  Specifically, we are considering billing for an ultrasound scan to measuring bladder volume/retained urine and aorta scans to rule out an abdominal aortic aneurism. We are looking at CPT^® 76775 for the aorta and code 51798 for bladder volume, both diagnostic procedures our emergency physicians regularly perform. Are there are specific documentation requirements to qualify for billing these services and if so what are the requirements?

New Mexico Subscriber

Answer: Many groups do successfully report and receive payment for interpreting ultrasound services. Because most groups don’t own the ultrasound equipment, report the professional component of the ultrasound service by appending the -26 modifier to the appropriate code, even if the physician is personally doing the scan rather than an ultrasound tech.

All diagnostic ultrasound examinations require permanently archived images and a written interpretive report for inclusion in the medical record. CPT^® language is often very specific in the description of the exact organs or anatomical structures to mention in the interpretive report when choosing that particular code, so review those code descriptors and the relevant preambles carefully before choosing the code to describe your service. Pay particular attention to the complete vs. limited code descriptors.

For example, CPT^® instructs, “A complete ultrasound examination of the retroperitoneum (76770) consists of real time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality. Alternatively, if clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound.” The expectation is that the interpretive report would note all the listed elements or an explanation as to why those elements could not be visualized.

By contrast, code 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited) suggests that your scan documentation was less than that the code descriptor required for the complete scan. Code 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) describes only the technical involvement of that service with no physician work included, and correspondingly carries a work value of zero, so using that code is  harder to substantiate if you are only reporting the professional component of the service. This code appears in the urological section of CPT^® rather than the diagnostic ultrasound section.