Radiology Coding Alert

Question: I have two separate imaging reports for procedures performed on the same date of service, one was completed at 11:08 and the other was completed at 11:11. The first report is for ultrasound imaging of the abdominal aorta including color and spectral doppler evaluation. The second report is for ultrasound imaging of the complete abdomen with color doppler evaluation of the main portal vein with representative images.

How should we bill for this encounter?

Georgia Subscriber

Answer: You’ll assign two separate CPT^® codes for the encounter. Start with 76770 (Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete) to report the complete abdominal ultrasound, and then assign 76775 (… limited) to report the ultrasound of the abdominal aorta. You’ll also append an appropriate modifier to 76775 to indicate the provider performed a separate limited ultrasound in addition to the complete ultrasound.

Of course, check with your individual payer to confirm if they want you to append 76775 with modifier 59 (Distinct procedural service) or XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service).

You should also be prepared to appeal if the claim is denied, since 76775 is a component of 76770. The National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit pairs bundle 76775 into 76770 and features a modifier indicator of “1.” This means that you can correctly report 76770 and 76775 separately on the same claim with the correct modifier and if the documentation shows the two procedures were performed separately.

If your claim is denied, you can appeal the denial and submit medical documentation that indicates the medical necessity for a complete and a limited retroperitoneal ultrasound on the same date of service.