Radiology Coding Alert

Question: May I report more than one unit of 76856?

Codify Member

Answer: Generally speaking, you may not report multiple units of 76856 (Ultrasound, pelvic [nonobstetric], real time with image documentation; complete). For 76856, Medicare lists an edit of "1" in the Medically Unlikely Edits (MUEs). That means the expectation is that in the vast majority of cases, a maximum of 1 unit will be appropriate.

If the physician performs a second ultrasound, consider whether 76857 (... limited or follow-up [e.g., for follicles]) would apply. Medicare also lists an MUE of 1 for 76857.

You may override an MUE (using an appropriate modifier) when your radiologist performs and documents a medically necessary number of services that exceed the limit, but be prepared to support your coding choice. Published MUEs are available from www.cms.gov/NationalCorrectCodInitEd/.