Radiology Coding Alert

The phrase "includes mediastinum" in 76604's descriptor raises a question: Must the service include a mediastinum exam?

AMA's CPT Assistant (May 2009) erases the confusion by providing a clear answer: No. Instead, the phrase "includes mediastinum" indicates that if the provider performs and documents an examination of the mediastinum, you should include it in chest US code 76604 (Ultrasound, chest [includes mediastinum], real time with image documentation), says Elijah Berg, MD, FACEP, CEO of MRSI, a coding and billing company in Woburn, Mass.

In other words: While the code descriptor does mention a mediastinum exam explicitly, you can report 76604 regardless of whether the physician documents examination of the area. You cannot, however, report a mediastinum exam separately if the physician notes it during a chest US.

Mediastinum defined: According to Dorland's Dictionary, the mediastinum is "the mass of tissues and organs between the sternum anteriorly and the vertebral column posteriorly and from the thoracic inlet superiorly to the diaphragm inferiorly. It contains the heart and pericardium, the bases of the great vessels, the trachea and bronchi, esophagus, thymus, lymph nodes, thoracic duct, phrenic and vagus nerves, and other structures and tissues."