ED Coding and Reimbursement Alert

Question: Which CPT® code is used to report the ultrasound examination of a palpable mass in the groin?  There is a discussion going on in a medical coding forum about it, with some saying it should be 76870 quoting CPT Assistant® and others saying 76882 is correct quoting ACR. Who is right?

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Answer: The code choice will depend on the documentation of where the soft tissue mass is located.

By medical definition, the groin is the fold or depression marking the juncture of the lower abdomen and the inner part of the thigh, or the region of that line. Not unlike the question of when the forehead becomes the scalp on a bald man, there is room for reasonable people to disagree what is meant by groin.

We might all know what is meant by a "groin pull", and there seems little doubt about what is meant by being "kicked in the groin", but in this context the location is not really clear.

A soft tissue mass in the groin could actually be located in the lower abdomen, the upper thigh, or the scrotum. CPT® offers ultrasound codes dealing with each of those locations.

• 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up])
• 76882 (Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific)
• 76870 (Ultrasound, scrotum and contents)

Of note: the professional component, meaning the interpretation and report of the ultrasound, of the three codes all are different.

Code 76705 is valued at 0.84 RVUs and paid at $28.59

Code 76870 is valued at 0.92 RVUs and paid at $31.31

Code 76882 is valued at 0.70 RVUs and paid at $23.83

The May 2009 issue of CPT Assistant® published a list of codes that would be reported for soft tissue ultrasound of a specific site based on input from ACR and ACEP. That list included:

• Neck - 76536
• Upper extremity - 76882
• Axilla - 76882
• Chest wall - 76604
• Upper back - 76604
• Lower back - 76705
• Abdominal wall - 76705
• Pelvic wall - 76857
• Buttock - 76857
• Groin - 76870
• Perineum - 76857
• Lower Extremity - 76882
• Other soft tissue -- 76999

Your best bet it to choose the code that most accurately matches the chart documentation as to the location. If it is not clear, seek clarification from the provider.