Radiology Coding Alert

Question: Our techs say the liver and spleen are in different quadrants, so we should bill complete abdominal ultrasounds for this service. Is this correct?

Connecticut Subscriber

Answer: For a liver and spleen ultrasound, you should report a limited exam: 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]).

Although the descriptor includes a single organ or a single quadrant, these are only possible examples. Imaging two organs does not meet the requirements for a complete ultrasound (76700, ... complete), so you should use the limited exam.

Here's why: CPT's "Diagnostic Ultrasound" section guidelines specify that for a complete exam, the report should contain a description of the elements CPT states comprise a complete exam for that anatomic area "or the reason that an element could not be visualized (e.g., obscured by bowel gas, surgically absent.)"

If you don't meet these requirements, the guidelines instruct you to use the limited code. Examples of when a limited code would be appropriate include a "limited number of organs or limited portion of region evaluated."

For you to report a complete abdominal ultrasound (76700), the documentation must describe the following elements (or explain why they can't be visualized), according to CPT's "Abdomen and Retroperitoneum" ultrasound guidelines:

• liver

• gallbladder

• common bile duct

• pancreas

• spleen

• kidneys

• upper abdominal aorta

• inferior vena cava (IVC).

The radiologist also should note any abdominal abnormality present.