Radiology Coding Alert

Choose correctly between these abdominal aorta ultrasound/duplex scan codes.

You’re already aware of 2017’s new abdominal aorta ultrasound code for abdominal aortic aneurysm (AAA) screenings, 76706 (Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm [AAA]).

While this code, on its own, sounds simple enough, choosing between the broad range of abdominal aorta ultrasound and duplex codes requires a little more thought before making the correct choice.

We’ll provide you with some go-to options in the case that you find yourself unsure of which ultrasound code to apply.

Decide to Screen, or Not to Screen

If the provider orders a screening ultrasound for an AAA, then you know to immediately apply code 76706. Physicians will usually order this exam for individuals with a history of AAA or other cardiovascular symptoms or diseases. Remember that the decision to use 76706 will be determined by the title of the exam ordered, not based on the technique, body of the report, or the impression. For example, if an AAA is discovered on a routine abdominal aorta ultrasound, you will NOT apply code 76706 — only if the procedure was originally ordered as a means of screening for an AAA.

Consider Non-screening Options

When you’re not coding for AAA screening ultrasounds, you’ll generally be choosing between a US retroperitoneal and a duplex scan of the aorta, inferior vena cava, iliac vasculature, and/or bypass grafts. When the physician orders a complete duplex scan, make sure each of these anatomical variants are documented in the body of the report. If they are, you’ll want to use code 93978 (Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study). Providers order some duplex scans exclusively to monitor the aorta or surrounding vessels. In these cases, use 93979 (Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study).

Your only other options for ultrasound aortic imaging are 76770 (Ultrasound, retroperitoneal [eg, renal, aorta, nodes], real time with image documentation; complete) and 76775 (Ultrasound, retroperitoneal [eg, renal, aorta, nodes], real time with image documentation; limited). Similar to the duplex scans, you’ll want to confirm that all three structures (kidney, aorta, lymph nodes) are documented in order to code the complete study.

Beware: If a duplex scan is ordered with an indication of AAA screening, you may want to flag the claim for the provider to review. Your local coverage determination (LCD) edits will restrict you from using code Z13.6 (Encounter for screening for cardiovascular disorders) as a primary diagnosis. If there is no additional indicating diagnosis and/or no diagnosis in the impression related to the patient’s cardiovascular health, you will want to send this report back to the physician to see if an addendum can be made.

Use Z13.6 with 76706 in Addition to a Secondary Code

LCDs have not yet been established for code 76706. When billing for this procedure, use Z13.6 as the primary diagnosis. The (deleted) predecessor to 76706, G0389 (Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening), required a secondary risk factor diagnosis code. In order to avoid a denial, you will want to include one of two risk factor codes; one for family history of AAA and/or one for a history of smoking:

• Z82.49, Family history of ischemic heart disease and other diseases of the circulatory system »
• Z87.891, Personal history of nicotine dependence

​Clarification: Coding Correction on Mammography 101 Article

We would like to provide an update on a correction to volume 19, issue 6 of the Radiology Coding Alert. This article, titled “Mammography 101,” references the use of modifier GG (Performance and payment of a screening mammography and diagnostic mammography on same patient same day) on claims in which a diagnostic and screening mammogram are performed on the same day. The article incorrectly instructs you to apply modifier GG to the diagnostic mammogram, when, in fact, you should apply modifier GG to the screening mammogram in the instance that these procedures are performed on the same visit.

Refresher: In order to qualify for a US aorta AAA screening, patients must meet one of the following criteria:

• Patient has a family history of abdominal aortic aneurysm.
• Patient is a man between the ages of 65-75 who has smoked at least 100 cigarettes in his lifetime.
• Patient is a beneficiary who manifests other risk factors in a beneficiary category recommended for screening by the United States Preventive Services Task Force regarding AAA, as specified by the Secretary of Health and Human Services, through the national coverage determination (NCD) process.

Based on these criteria, it’s likely that the patient will have either a family history of AAA or a personal history of smoking. If neither of these are documented, flag the report for review.