Ask the Expert

This month’s selection:
My coworkers and I are looking for advice on coding and reimbursement for CPT 76705. Our trauma surgeons purchased a portable ultrasound machine that is kept in the trauma bay at the hospital and is used only by the trauma surgeons in trauma cases. The problem we are encountering is the claims are being denied as a physician billing for POS emergency department, outpatient hospital, inpatient hospital, etc. Even if we attempt to bill for only the interpretation portion, we are still receiving denials because the carrier never receives a claim for the technical portion from the hospital.

Cristy Donaldson, CPC, CPMA
Knoxville, Tennessee

 

Response:
First, this could be a circumstance where the practice described is “standard of care” and thus this is not separately payable by many third parties. Secondly, if the trauma surgeons are using the ultrasound to assess damage to internal organs without keeping a permanent tracing or producing a formal report, this service is not billable.

The CPT book specifically states, “Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation and final, written report, is not separately reportable.” The article “Toward Best Practices in Radiology Reporting” published in Radiology in September 2009 includes a guideline listing the components to be documented in a radiology report.

And finally, the code description also may offer a clue to another consideration. The code description is “Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up).” To use the follow-up code, the complete code needs to be billed initially. Per CPT, “A complete ultrasound examination of the abdomen (76700) consists of real time scans of the liver, gall bladder, common bile duct, pancreas, spleen, kidneys, and the upper abdominal aorta and inferior vena cava including any demonstrated abdominal abnormality.” Payers may deny use of the follow-up code if no “complete” exam had been billed.

— Christine Lee, MHA, RHIA, CCS, CPC, is manager of provider practices services at Care Communications.