If a renal ultrasound with doppler is performed how would you code this? Both co!
Question: If a renal ultrasound with doppler is performed how would you code this!? Both codes or one!?
Answers:
Hard to find but I hope this helps!.
Doppler Evaluation of Vascular Structures (other than color flow used for anatomical structure identification) is used, report the appropriate non-invasive vascular diagnostic studies code in the Medicine Section of CPT?!. For urology, these codes include:
93975
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study
93976
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study
93980
Duplex scan of arterial inflow and venous outflow of penile vessels; complete study
93981
Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study
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Post-voiding Residual Urine
51798
Measurement of post-voiding residual urine and/or bladder capacity by ultrasound; non-imaging
Another source of confusion for coders is the wording of CPT? code 51798; specifically the term "non-imaging!." When this CPT? code was first implemented in 2003 as a replacement for HCPCS code G0050, Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, its use was dependent on the type of ultrasound machine and the image obtained!. In other words, the basis for CPT? coding was whether or not an image was obtained!. The Coding and Reimbursement Committee of the AUA reviewed this issue and decided that regardless of the type of ultrasound machine used or whether an image was obtained, if the intent of the diagnostic procedure is to obtain only a post-voiding residual urine, then CPT? code 51798 is appropriate!.
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Abdomen
76700
Ultrasound, abdominal, B-scan and/or real time with image documentation; complete
A complete ultrasound examination of the abdomen consists of a B-mode scans of: the liver, gallbladder, common bile duct, pancreas, spleen, kidneys and the upper abdominal aorta and inferior vena cava including any demonstrated abdominal abnormality!.
A separate written report should include comments on all these organs and elements and the findings!. If particular elements cannot be visualized, the reason should be documented!.
76705
Ultrasound, abdominal, B-scan and/or real time with image documentation, limited (e!.g!., single organ, quadrant, follow-up)
This "limited" CPT? code captures a focused examination in the assessment of one or more elements listed in the "complete" ultrasound above!. If you do not visualize all the elements outlined in the "complete" description, the limited CPT? code 76705 should be used!.
A separate written report should be included in the patient's chart as well as any images obtained during the ultrasonic procedure!.
Retroperitoneum
76770
Ultrasound, retroperitoneal (e!.g!., renal, aorta, nodes), B-scan and/or real time with image documentation; complete
A complete ultrasound of the retroperitoneum consists of B-mode scans of: the kidneys, abdominal aorta, common iliac artery origins and inferior vena cava, including any demonstrated retroperitoneal abnormality!. If the clinical history suggests urinary tract pathology, a complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound!. Therefore, it is not appropriate to report additional ultrasound codes (such as abdominal or pelvic) for an evaluation of the kidneys and bladder!.
76775
Ultrasound, retroperitoneal (e!.g!., renal, aorta, nodes), B-scan and/or real time with image documentation; limited
This "limited" CPT? code captures a focused examination in the assessment of one or more elements listed in the "complete!." If all of the specified elements outlined in the "complete" description are not visualized by ultrasound and documented, then the "limited" CPT? code 76775 should be used!. A separate, final written report should be included in the patient's chart as well as any images obtained during the ultrasonic procedure!.
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Pelvis
76856
Ultrasound, pelvic (nonobstetric), B-scan and/or real time with image documentation; complete
Pelvic ultrasound codes are used for both female and male anatomy!.
Elements of a complete female pelvic examination include a description and measurement of the uterus and adnexal structures, endometrium, bladder, and of any pelvic pathology (e!.g!., ovarian cysts, uterine leiomyomata, free pelvic fluid)!.
Elements of a complete male pelvic examination include the evaluation and measurement (when applicable) of the urinary bladder, prostate and seminal vesicles to the extent they are visualized transabdominally, and any pelvic pathology (e!.g!., bladder tumor, enlarged prostate, free pelvic fluid, pelvic abscess)!.
A separate written report should comment on all the findings of these organs!. If particular elements cannot be visualized, the reason should be documented!.
76857
Ultrasound, pelvic (nonobstetric), B-Scan and/or real time with image documentation; limited or follow-up (e!.g!., for follicles)
This "limited" CPT? code captures a focused examination in the assessment of one or more elements listed in the "complete" pelvic ultrasound CPT? code 76856!. It also captures the reevaluation of one or more pelvic abnormalities previously demonstrated on ultrasound!. A separate written report should be dictated and included in the patient's medical chart!.
This code should be selected if the urinary bladder alone (not including the kidneys) is imaged (B-scan and/or real time)!. Do not use CPT? code 76770!. If post-voiding residual urine is obtained and the imaging of the bladder is obtained but not medically necessary, use CPT? code 51798 as discussed above!.
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Prostate - Ultrasound and Ultrasonic Guidance Procedures
Prostate Biopsy
76872
Ultrasound, transrectal
It is the standard of care to perform a sonographic evaluation of the prostate for any abnormality prior to a prostate biopsy!. These abnormalities will be shown as hypoechoic areas or lesions that need further diagnostic investigation!. This sonographic evaluation determines whether the physician should continue with prostate biopsy!. A separate report for this diagnostic evaluation is required!. This formal report should be signed by the physician and included in the patient's chart!.
76942
Ultrasonic guidance for needle placement (e!.g!., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
As described above, if there are questionable areas the physician will normally continue with the sonographically guided biopsy of the prostate!. To obtain specimens of the questionable areas, it is important that the physician direct the biopsy needle accurately and this type of sonogram is an essential part of the procedure to assure the proper placement of the needle!.
In addition to the ultrasound codes, it is appropriate to bill the biopsy code:
55700
Biopsy, prostate; needle or punch, single or multiple, any approach
In a hospital setting, when a urologist and a radiologist perform the prostate biopsy procedure together, the urologist reports CPT? code 55700 and the radiologist reports CPT? code 76942!. If the urologist performs the CPT? code 76872, Ultrasound, transrectal, then he should append modifier -26, Professional Component!. If the radiologist performs the transrectal ultrasound prior to the ultrasonically guided prostate biopsy, then the radiologist would bill using CPT? code 76872!.
It is also important to include a written report on the ultrasonic guidance procedure!. This report may be either separately documented or included within the report of the procedure!.
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Brachytherapy
76873
Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)
Prior to brachytherapy treatment, a prostate volume study is performed taking 5 mm cuts or pictures to plan where the radioactive seeds are to be placed in the prostate!. This study aids the radiotherapist in the placement of the seeds into the catheters or needles for placement in the prostate!.
A separate report for this diagnostic evaluation is required that documents the size and volume of the prostate for treatment planning prior to the actual brachytherapy treatment!. A formal report is signed by the physician and included in the patient's chart!.
76965
Ultrasonic guidance for interstitial radioelement application
This CPT? code captures the ultrasonic guidance necessary to implant the radioactive seeds for brachytherapy treatment!.
It is also appropriate to include a final written report on the ultrasonic guidance procedure!. This report may be either separately documented or included within the report of the procedure for which the guidance is necessary!.
In addition to the ultrasonic guidance CPT? code, it is also appropriate to report:
55859
Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy
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Scrotum and Contents
76870
Ultrasound, scrotum and contents
This CPT? code describes the sonographic evaluation of the scrotum and its contents!. A separate, written report documenting any scrotal abnormalities must be dictated and included in the patient's medical chart!.
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Unlisted Ultrasound
76999
Unlisted ultrasound procedure
Use this code if there are no other CPT? codes to describe the ultrasound procedure performed!.
The AUA has devWww@Answer-Health@Com
Doppler Evaluation of Vascular Structures (other than color flow used for anatomical structure identification) is used, report the appropriate non-invasive vascular diagnostic studies code in the Medicine Section of CPT?!. For urology, these codes include:
93975
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study
93976
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study
93980
Duplex scan of arterial inflow and venous outflow of penile vessels; complete study
93981
Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study
back to top
Post-voiding Residual Urine
51798
Measurement of post-voiding residual urine and/or bladder capacity by ultrasound; non-imaging
Another source of confusion for coders is the wording of CPT? code 51798; specifically the term "non-imaging!." When this CPT? code was first implemented in 2003 as a replacement for HCPCS code G0050, Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, its use was dependent on the type of ultrasound machine and the image obtained!. In other words, the basis for CPT? coding was whether or not an image was obtained!. The Coding and Reimbursement Committee of the AUA reviewed this issue and decided that regardless of the type of ultrasound machine used or whether an image was obtained, if the intent of the diagnostic procedure is to obtain only a post-voiding residual urine, then CPT? code 51798 is appropriate!.
back to top
Abdomen
76700
Ultrasound, abdominal, B-scan and/or real time with image documentation; complete
A complete ultrasound examination of the abdomen consists of a B-mode scans of: the liver, gallbladder, common bile duct, pancreas, spleen, kidneys and the upper abdominal aorta and inferior vena cava including any demonstrated abdominal abnormality!.
A separate written report should include comments on all these organs and elements and the findings!. If particular elements cannot be visualized, the reason should be documented!.
76705
Ultrasound, abdominal, B-scan and/or real time with image documentation, limited (e!.g!., single organ, quadrant, follow-up)
This "limited" CPT? code captures a focused examination in the assessment of one or more elements listed in the "complete" ultrasound above!. If you do not visualize all the elements outlined in the "complete" description, the limited CPT? code 76705 should be used!.
A separate written report should be included in the patient's chart as well as any images obtained during the ultrasonic procedure!.
Retroperitoneum
76770
Ultrasound, retroperitoneal (e!.g!., renal, aorta, nodes), B-scan and/or real time with image documentation; complete
A complete ultrasound of the retroperitoneum consists of B-mode scans of: the kidneys, abdominal aorta, common iliac artery origins and inferior vena cava, including any demonstrated retroperitoneal abnormality!. If the clinical history suggests urinary tract pathology, a complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound!. Therefore, it is not appropriate to report additional ultrasound codes (such as abdominal or pelvic) for an evaluation of the kidneys and bladder!.
76775
Ultrasound, retroperitoneal (e!.g!., renal, aorta, nodes), B-scan and/or real time with image documentation; limited
This "limited" CPT? code captures a focused examination in the assessment of one or more elements listed in the "complete!." If all of the specified elements outlined in the "complete" description are not visualized by ultrasound and documented, then the "limited" CPT? code 76775 should be used!. A separate, final written report should be included in the patient's chart as well as any images obtained during the ultrasonic procedure!.
back to top
Pelvis
76856
Ultrasound, pelvic (nonobstetric), B-scan and/or real time with image documentation; complete
Pelvic ultrasound codes are used for both female and male anatomy!.
Elements of a complete female pelvic examination include a description and measurement of the uterus and adnexal structures, endometrium, bladder, and of any pelvic pathology (e!.g!., ovarian cysts, uterine leiomyomata, free pelvic fluid)!.
Elements of a complete male pelvic examination include the evaluation and measurement (when applicable) of the urinary bladder, prostate and seminal vesicles to the extent they are visualized transabdominally, and any pelvic pathology (e!.g!., bladder tumor, enlarged prostate, free pelvic fluid, pelvic abscess)!.
A separate written report should comment on all the findings of these organs!. If particular elements cannot be visualized, the reason should be documented!.
76857
Ultrasound, pelvic (nonobstetric), B-Scan and/or real time with image documentation; limited or follow-up (e!.g!., for follicles)
This "limited" CPT? code captures a focused examination in the assessment of one or more elements listed in the "complete" pelvic ultrasound CPT? code 76856!. It also captures the reevaluation of one or more pelvic abnormalities previously demonstrated on ultrasound!. A separate written report should be dictated and included in the patient's medical chart!.
This code should be selected if the urinary bladder alone (not including the kidneys) is imaged (B-scan and/or real time)!. Do not use CPT? code 76770!. If post-voiding residual urine is obtained and the imaging of the bladder is obtained but not medically necessary, use CPT? code 51798 as discussed above!.
back to top
Prostate - Ultrasound and Ultrasonic Guidance Procedures
Prostate Biopsy
76872
Ultrasound, transrectal
It is the standard of care to perform a sonographic evaluation of the prostate for any abnormality prior to a prostate biopsy!. These abnormalities will be shown as hypoechoic areas or lesions that need further diagnostic investigation!. This sonographic evaluation determines whether the physician should continue with prostate biopsy!. A separate report for this diagnostic evaluation is required!. This formal report should be signed by the physician and included in the patient's chart!.
76942
Ultrasonic guidance for needle placement (e!.g!., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
As described above, if there are questionable areas the physician will normally continue with the sonographically guided biopsy of the prostate!. To obtain specimens of the questionable areas, it is important that the physician direct the biopsy needle accurately and this type of sonogram is an essential part of the procedure to assure the proper placement of the needle!.
In addition to the ultrasound codes, it is appropriate to bill the biopsy code:
55700
Biopsy, prostate; needle or punch, single or multiple, any approach
In a hospital setting, when a urologist and a radiologist perform the prostate biopsy procedure together, the urologist reports CPT? code 55700 and the radiologist reports CPT? code 76942!. If the urologist performs the CPT? code 76872, Ultrasound, transrectal, then he should append modifier -26, Professional Component!. If the radiologist performs the transrectal ultrasound prior to the ultrasonically guided prostate biopsy, then the radiologist would bill using CPT? code 76872!.
It is also important to include a written report on the ultrasonic guidance procedure!. This report may be either separately documented or included within the report of the procedure!.
back to top
Brachytherapy
76873
Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)
Prior to brachytherapy treatment, a prostate volume study is performed taking 5 mm cuts or pictures to plan where the radioactive seeds are to be placed in the prostate!. This study aids the radiotherapist in the placement of the seeds into the catheters or needles for placement in the prostate!.
A separate report for this diagnostic evaluation is required that documents the size and volume of the prostate for treatment planning prior to the actual brachytherapy treatment!. A formal report is signed by the physician and included in the patient's chart!.
76965
Ultrasonic guidance for interstitial radioelement application
This CPT? code captures the ultrasonic guidance necessary to implant the radioactive seeds for brachytherapy treatment!.
It is also appropriate to include a final written report on the ultrasonic guidance procedure!. This report may be either separately documented or included within the report of the procedure for which the guidance is necessary!.
In addition to the ultrasonic guidance CPT? code, it is also appropriate to report:
55859
Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy
back to top
Scrotum and Contents
76870
Ultrasound, scrotum and contents
This CPT? code describes the sonographic evaluation of the scrotum and its contents!. A separate, written report documenting any scrotal abnormalities must be dictated and included in the patient's medical chart!.
back to top
Unlisted Ultrasound
76999
Unlisted ultrasound procedure
Use this code if there are no other CPT? codes to describe the ultrasound procedure performed!.
The AUA has devWww@Answer-Health@Com