Radiology Coding Alert

Don’t assume the same limited code applies to kidney-only and bladder-only studies.

Listing the main structures of the urinary system doesn’t take long, but that doesn’t mean coding for this system is simple. There are some twists and turns to reporting ultrasound imaging of the complete system as well as its parts.

Picture Anatomy for Better Coding

Urologic radiology focuses on the urinary system. Major components include the kidneys, ureters, urinary bladder, and urethra. In normal anatomy, a patient has both a left kidney and a right kidney. Each kidney is connected to the urinary bladder by a ureter. The urethra then functions to carry urine from the bladder to the exterior of the body. (See Figure 1.)

Capture Complete US for Just Kidney and Bladder

Before choosing an ultrasound code for imaging of urinary structures, be sure to read the CPT^® guidelines. You may be surprised by which codes apply to the different studies.

For patients with a clinical history suggesting urinary tract pathology, complete evaluation of the kidneys and urinary bladder supports coding a complete retroperitoneal ultrasound, said Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook, in a recent presentation for AudioEducator.com.

You’ll find this rule in the CPT^® guidelines. The proper code is 76770 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; complete).

This urinary tract pathology exception is important because otherwise 76770 would require “real time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality,” CPT^® guidelines state.

Diagnosis: Diagnoses that may support a clinical history of urinary tract pathology include (but aren’t limited to):

·         Dysuria and painful urination (ICD-9: 788.1, Dysuria; ICD-10: R30.0, Dysuria; R30.9, Painful micturition, unspecified)

·         Frequent urination and polyuria (ICD-9: 788.4x, Frequency of urination and polyuria; ICD-10, R35.-, Polyuria)

·         Flank pain (ICD-9: 789.0x, Abdominal pain; ICD-10: R10.-, Abdominal and pelvic pain).

Keep Complete/Limited in Mind for Kidneys

We’ve established that coding guidelines allow you to report complete retroperitoneal code 76770 for imaging of the kidneys and bladder in certain patients. That raises the question of proper coding for ultrasound of the kidneys only and ultrasound of the bladder only. Let’s start with the kidneys.

CPT^® guidelines state, “If less than the required elements for a ‘complete’ exam are reported (e.g., limited number of organs or limited portion of region evaluated), the ‘limited’ code for that anatomic region should be used once per patient exam session.”

A logical assumption is that if the complete retroperitoneal code applies to the kidneys and bladder, then the limited code applies to ultrasound of the kidneys only.

In the case of kidneys, that assumption is correct. Note the use of the term “renal” in the definition of 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited). Renal means related to the kidneys. So for ultrasound of the kidneys only, you should report 76775.

Look Beyond 76775 for Bladder Imaging

Although the limited retroperitoneal code is appropriate for ultrasound of the kidneys only, you should not use a retroperitoneal code for imaging of just the bladder anatomy, said Ferragamo.

Instead, you should use limited pelvic ultrasound code 76857 (Ultrasound, pelvic [nonobstetric], real time with image documentation; limited or follow-up [e.g., for follicles]). CPT^® guidelines state that “Code 76857, rather than 76770, should be utilized if the urinary bladder alone (i.e., not including the kidneys) is imaged.”

Tip: Documentation of a bladder anatomy ultrasound may include discussion of the bladder wall, any diverticula (small pouches that may be present in the bladder) and whether any stones are present there, the bladder interior including presence of any tumors or stones, and for male patients whether an enlarged prostate is making an impression on the bladder, said Ferragamo.