Radiology Coding Alert

Beware of overcoding tendon or muscle scan.

A remarkable rise in the number of extremity ultrasounds in the last few years brought about one deletion and two additions to CPT that you need to know.

CPT 2011 replaces 76880 (Ultrasound, extremity, nonvascular, real-time with image documentation) with the following:

• 76881 -- Ultrasound, extremity, nonvascular, real-time with image documentation; complete
• 76882 -- ... limited, anatomic specific.

76882 Guidelines Point You to 'Specific Anatomic Structure'

Together with the new codes, CPT also added new guidelines for 76881 and 76882, as was noted in the presentation by Richard Duszak, MD, FACR, FRBMA, RCC, CPT editorial panel member, at the AMA's CPT and RBRVS 2011 Annual Symposium in Chicago.

Complete: The guidelines instruct that complete code 76881 includes real time ultrasound scans of a joint. To be complete, the documentation should reference related "muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality."

Example: CPT Changes 2011: An Insider's View offers the example of a complete exam of the ankle, including all of the following:

• Lateral structures (for example, peroneus tendons; fibular ligaments)
• Medial structures (for example, posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons; deltoid ligament; neurovascular bundle)
• Anterior structures (for example, tibialis anterior tendon; ankle joint)
• Posterior structures (for example, Achilles tendon; retrocalcaneal and retroachilles bursa).

Limited: In contrast, limited study code 76882 applies to the examination of a specific anatomic structure, including a muscle, tendon, joint, or other soft tissue, Duszak's presentation explained.

Guidelines for 76882 also explain that the code is appropriate for evaluation of a soft-tissue mass if the physician needs to learn its cystic or solid characteristics.

Example 1: CPT Changes 2011: An Insider's View offers the example of a focused exam (in multiple planes) of the Achilles tendon for an injured patient. This limited exam merits 76882.

Example 2: A diabetic patient presents with pain and swelling over the left leg. The physician performs a limited ultrasound to determine the presence of an abscess.

In this case, you again should report 76882, says Michael Granovsky, MD, CPC, FACEP, president of MRSI, a coding and billing company in Woburn, Mass.

Expect $9 to $85 Difference in Fees Between Codes

Change rationale: Code 76880 increased in use significantly in the last several years. The AMA RUC Five-Year Review Identification Workgroup assessed the code use. Evidence suggested that limited exams made up the bulk of the increase, CPT Changes 2011 notes. Because the work and practice expense differ greatly for complete and limited exams, CPT decided two separate codes would be a more accurate way of identifying the services performed.

The difference in work is reflected in the rates for these new codes. Although the professional rates are fairly similar, the technical and global (professional plus technical) rates for these codes vary greatly.

The national rate for global complete code 76881 is roughly $115, according to the 2011 Medicare Physician Fee Schedule. Global 76882 will bring in closer to $30, which is a difference of about $85.

The professional component of 76881 should yield almost $29, and 76882 is slightly lower at about $20. So if you do the math, you see that the technical component fee for 76881 is about $86, while technical 76882 yields close to $10.