Gastroenterology Coding Alert

Question: How should we code for a rectal endoscopic ultrasound?

Mississippi Subscriber

Answer: Use code 76872 (Ultrasound, transrectal) to bill for this procedure. This service has both a technical component and a professional component. The technical component represents the value assigned to the ownership and maintenance of the equipment and the use of any technicians. For a gastroenterologist to bill for the technical component of any diagnostic service, she must own (or partially own by being a partner in a practice) the equipment being used.

The professional component represents the gastroenterologist’s interpretation of the test results. When the gastroenterologist only does the interpretation of the rectal endoscopic ultrasound, then she may bill for reimbursement of the professional component by attaching modifier 26 (Professional component) to code 76872.

If the gastroenterologist both owns the equipment and interprets the test results, she may bill for reimbursement of both the technical and professional components using code 76872 without any modifier.

This procedure, however, is performed by radiologists most commonly, using a probe passed rectally and not an endoscope.

Gastroenterologists may be tempted to use code 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation) to bill for this or for endoscopic procedure interpretation. That code, however, cannot be used when the ultrasound is done in conjunction with a gastrointestinal endoscopic procedure. CPT^® instructions are “Do not report 76975 in conjunction with 43231, 43232, 43237, 43238, 43240, 43242, 43259, 44406, 44407, 45341, 45342, 45391, 45392, 76942 … All endoscopic procedures include the work
of interpretation and report.”