Radiology Coding Alert

Question: I am confused about abdominal ultrasounds, specifically CPT Codes 76700 and 76770. Can you clarify coding of these two?

Anonymous Washington, DC Subscriber

Answer: Both codes refer to complete ultrasound exams. Part of the reason for the confusion is that some of the organs that are typically examined under the abdominal code 76700 (echography, abdominal, B-scan, and/or real time with image documentation; complete) may also be viewed when a retroperitoneal ultrasound is performed76770 (echography, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; complete).

According to the 1999 ACR (American College of Radiology) Ultrasound Coding Users Guide, 76700 should be assigned for complete ultrasound exams that focus primarily on the upper abdominal region from the diaphragm to the level of the umbilicus. This will typically include the liver, spleen, gallbladder, common duct, pancreas and the hollow upper abdominal viscera. Code 76700 may also include examination of specific vessels like the inferior vena cava and the upper abdominal aorta.

If, however, the complete exam is intended to study organs typically included as retroperitoneum, the correct code is 76770. The ACR defines a complete retroperitoneal study as including images of the aorta, inferior vena cava, retroperitoneal structures and retroperitoneal lymph nodes. The urinary tractkidneys, bladder and uretersalso may be included in this exam.

If the exam entails anything less than a complete study of each of these physiological regions, the corresponding limited ultrasound code should be assigned. Limited abdominal code (e.g., single organ, quadrant, follow-up) is 76705. Limited retroperitoneum code is 76775.