ED Coding and Reimbursement Alert

Question: If an ED physician performs a bladder scan for residual urine and provides a complete interpretation of findings, should we code 76775 or 76705? Since these codes are in CPT's radiology section, does the procedure code require a modifier when an ED doctor performs the service? If the physician simply provides a complete interpretation of findings, should I append modifier -26?

New Hampshire Subscriber

Answer: All physicians may report the appropriate codes for services they are licensed to provide, regardless of specialty. If an ED physician interprets and writes a report for a radiology service, it is correct for coders to assign the corresponding code.

Modifier -26 (Professional component) must be appended to the radiological supervision and interpretation code to indicate that this was the professional component only and did not include the technical component. This causes some controversy because the physician performed the procedure in addition to its interpretation. Modifier -TC (Technical component) is based on who owns the equipment. ED physicians generally use technical equipment owned by the hospital or care center, and should append modifier -26 instead of reporting the global service.

The ED practice should use 76775-26 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) if the sonogram focused on a single quadrant or single organ of the retroperitonium. Likewise, 76705-26 (Ultrasound, abdominal, B-scan and/or real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is reported when the study encompasses the abdomen.

Coders are often confused about when to report abdominal ultrasounds as opposed to retroperitoneal ultrasounds. Much of the confusion occurs because some of the organs that are examined under the abdominal code may also be viewed when a retroperitoneal ultrasound is performed. According to the American College of Radiology's Ultrasound Coding User's Guide, abdominal codes should be assigned for ultrasound exams that focus primarily on the upper abdominal region from the diaphragm to the level of the umbilicus. This usually includes the liver, spleen, gallbladder, common duct, pancreas and the hollow upper abdominal viscera. These codes may also include examination of specific vessels like the inferior vena cava and the upper abdominal aorta. The retroperitonium often includes images of the aorta, inferior vena cava, retroperi-toneal structures, and retroperitoneal lymph nodes. The urinary tract organs kidneys, bladder and ureters are also classified as retroperitoneal organs. With a bladder scan, 76775-26 is the most appropriate study to report.

If organs other than the bladder were imaged, you must consider other coding alternatives. If the entire retroperitoneal region or a substantive portion of the region was studied during the ultrasound, 76770-26 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; complete) should be used. If multiple specific organs within the retroperitoneal region were evaluated, but the entire region was not, you should revert to 76775.