Radiology Coding Alert

Question: I am new to our billing department and am wondering when a radiology practice should use CPT 76857 (limited or follow-up) instead of 76856 (echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete).

Anonymous California Reader

Answer: A radiology practice rarely would assign code 76857, according to CPT and Darlene Zase, BS, CMPE, administrative director of Bridgeport Radiology Association in Fairfield, CT. Both codes reflect diagnostic or follow-up ultrasound scans, explains Zase. However, in most cases, the referring physician would order a complete scan (76856), even if it is a follow-up. For instance, this ultrasound scan may be performed on a female patient and the referring physician typically would want the radiologist to view both sides of the pelvic region. They may want to examine both ovaries, for example.

There are rare cases, Zase added, where a limited pelvic ultrasound may be conducted. Perhaps the patient has only one ovary due to a prior procedure. In those instances, perhaps, CPT code 76857 would be requested.