Radiology Coding Alert

Question: If the radiologist performs CPT 76775 and CPT 76857 for urinary tract (UT) pathology, should I report 76770 instead of those two codes? According to the new specific guidelines for 2005, limited kidney and bladder procedures constitute a complete 76770 for UT pathology.


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Answer: Look at the exact procedures performed and the reasons behind them before you decide how to report UT pathology ultrasounds. If you see documentation of two separate procedures (and usually for two separate diagnostic questions) meeting the requirements for 76775 and 76857, report these two codes instead of 76770. Note: It's much more common for the radiologist to perform only a complete retroperitoneal exam when the patient presents with urinary tract problems.

76770: According to CPT 2005, "If clinical history points to urinary tract pathology, complete evaluation of the kidneys and urinary bladder comprise a complete retroperitoneal ultrasound."

You report this with 76770 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B scan and/or real time with image documentation; complete).

76775: If the radiologist uses the sonogram to view the anatomy of the bladder, and evaluating post void residual urine isn't the main reason for the study, you may report code 76775 (... limited). You also use this code for viewing the kidneys alone (without mention of the urinary bladder). And report 76775 for an exam of other retroperitoneal structures (for example, the abdominal aorta or common iliac artery origins) without a complete retroperitoneal exam.

76857: CPT instructs you to report 76857 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles]) for "a focused examination limited to assessment of one or more elements listed in code 76856 and/or the reevaluation of one or more pelvic abnormalities previously demonstrated on ultrasound." Report 76857 rather than 76770 for imaging of the urinary bladder alone (i.e., not including kidneys).

Helpful: Don't report ultrasound without a thorough exam of organs or anatomic region, documentation of the image, and a final written report.