Basics of CPT code 76770, 76775, 93975 and 93976
Doppler and ultrasound exam makes a duplex exam. We have separate code for Ultrasound and duplex exam. But when we have to code them together we get confused. If you see there is nothing different about the procedure codes. Same thing happen while coding CPT code for renal ultrasound with doppler exam. If we know the exact procedure for these exams, its easy to code them. Let us learn about CPT code 76770, 76775, 93975 and 93976.
For Renal or kidney ultrasound exam we have a complete and limited ultrasound procedure code, similarly like abdomen complete (76700) and limited ultrasound (76705). Now, when we use CPT codes for renal ultrasound, the medical report documents or talks about structure or functional abnormality of retro-peritoneal organs.
Complete ultrasound CPT code 76770 should be used when their is full documentation to support. Per CPT, “A complete ultrasound examination of the retroperitoneum (76770) consists of real time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality.” Alternatively, if clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound.
Do not downcode the report to CPT code 76775, unless it is accepted by payers. Downcoding can lead to fraud and hence coders should very careful while coding such report.
But, Doppler or duplex exam of renal arteries/veins are different , they talk about the assessment of blood flow and recording with spectral waveform of the renal artery and/or veins. These exams help in diagnosing narrow or blocked renal arteries which may result in kidney failure or hypertension
The complete study code (CPT code 93975) describes duplex evaluation of arterial supply and venous drainage of an organ(s) in the abdomen, retroperitoneum, and/or pelvis. The code is the same whether one or more organs are evaluated. For organs that are bilateral, both should be completely assessed in order to report this code. The code is reported if the organs are evaluated in their entirety, including inflow and outflow vessels.
Major vessels supplying the blood flow to the organ or providing its venous drainage are also included in this code (eg, the aorta at a single level in a renal artery evaluation). If a gray scale evaluation of the involved organ is also performed, it is appropriate to additionally report a code from the 70000 series. Each individual procedure or service should be reported separately and/or have a separate paragraph within the report.
CPT code 93976 (limited study) is reported only when part of an organ is evaluated or the study is otherwise limited. It is also reported for a follow-up duplex investigation of an organ(s) (eg, evaluation of vascular supply of a transplanted liver). If a gray scale evaluation of the involved organ is also performed, it is appropriate to additionally report a code from the 70000 series. Each individual procedure or service should be reported separately and/or have a separate procedure note within the report.
Read also : How to self prepare for CPC exam
Difference Between Ultrasound, Doppler and Duplex
Conventional ultrasound (described by CPT code 76770 & 76775 in the 70000 series) refers to the use of high frequency sound waves which reflect off structures within the body. Real-time ultrasound is a 2-D scan that depicts structure and motion over time—like a “movie.”
Doppler ultrasound uses reflected sound waves to evaluate blood as it flows through a blood vessel. The sound waves bounce off blood cells in a motion that causes a change in the pitch of the sound, called the Doppler effect. If there is no blood flow, the pitch does not change.
Duplex ultrasound (Liek combines Doppler and conventional ultrasound, allowing the radiologist to see the structure of blood vessels, how the blood is flowing through the vessels, and whether there is any obstruction in the vessels. Color Doppler produces a picture of the blood vessel, and a computer converts the Doppler sounds into colors overlaid on the image, representing information about the speed and direction of blood flow. Using spectral Doppler analysis the duplex scan images provide anatomic and hemodynamic information, identifying the presence of any stenosis or plaque in the vessels.
When to use Cpt code 76770/76775 for renal ultrasound with Doppler?
When we have to code renal ultrasound report, we have a direct cpt code for that. But, when it is done with doppler studies, we have to check the documentation very carefully. Because, when a renal doppler exam is performed they will assess the renal artery or vein for proper blood flow. Cpt code for renal ultrasound with doppler will come together only when there are finding for ultrasound and doppler studies.
76770 – Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete
76775 – ……….limited
Read also: Learn when to code CPT code 93923
ICD 10 dx covered for Renal Doppler ultrasound CPT code 76770
Most of the renal diagnosis are covered for Renal ultrasound procedure. Usually the patient comes with a Flank pain (R10.9) for ultrasound renal exam. The pain is generally because of some obstruction in the renal pathway. The common diagnosis you will come across will be:
Hydronephrosis N13.30
Nephrolithiasis or Renal Stone N20.0
Ureteral Stone N20.1
Hematuria R31.9
Hydronephrosis with renal and ureteral calculous obstruction N13.2
Read also: When to use Transvaginal and Endovaginal Ultrasound CPT codes
Description of CPT code 76770, 76775, 93975 and 93976 for renal ultrasound with Doppler
Till now we know when to code both renal ultrasound and doppler together. So, let checkout the cpt codes used for renal ultrasound and doppler studies.
76770– ultrasound renal complete.
76775– ultrasound renal limited
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
Most important point to remember to code 93975 and 93976, please check for the assessment of flow with color, recording with spectral waveform and finding present in the report. Simply quick checking of whether the flow is present through doppler studies doesn’t qualify to code these cpts. Proper documentation should be present for coding cpt code for renal ultrasound with doppler.
Read also: Learn how to code a Medical Report
CCI Edits for CPT code 76770 & 76775 of renal ultrasound with doppler
As I have told you the Ultrasound is a part of duplex exam. Hence, when we are coding a duplex exam cpt code with ultrasound, we should use a modifier so that both procedure should get paid. Since, ultrasound is included in duplex exam we will have CCI edits when we code them together.
Hence, when we are coding renal ultrasound with duplex, the cpt code with ultrasound should be appended with 59 modifier. The 59 modifier will make ultrasound a distinct procedure from duplex exam and complete separate procedure. So, next time if you are coding 93975 or 93976 and 76770 or 76775 together, do check the CCI edits and use a 59 modifier with appropriate cpt.
| CPT code (column1) | CPT code (column2) | Modifier/Policy indicator |
|---|---|---|
| 93976 | 76770 | 1- allowed |
| 93976 | 76775 | 1- allowed |
| 93975 | 76770 | 1- allowed |
| 93875 | 76775 | 1- allowed |
CPT code 93976 (limited study) is reported only when part of an organ is evaluated or the study is otherwise limited. It is also reported for a follow-up duplex investigation of an organ(s) (eg, evaluation of vascular supply of a transplanted liver). If a gray scale evaluation of the involved organ is also performed, it is appropriate to additionally report a code from the 70000 series. Each individual procedure or service should be reported separately and/or have a separate procedure note within the report.
If spectral and color Doppler is medically necessary and is performed and documented, reporting code 93975 or 93976 may be appropriate. Note that national correct coding initiative (NCCI) edits are in place for the reporting of code 76856 with code 93975 or 93976, and a modifier is required to bypass the edits.
Do and Don’t with CPT code 76770
Do not code complete ultrasound CPT code 76770 & limited CPT code 76775 together. Limited exam is included in complete one, hence it should not be reported separately.Only the procedure code 76770 will be paid.
Do use X{EPSU} modifier while coding CPT code 76770 or 76775 along with 93975/93976.
Hope, now you are confident to code cpt code for renal with doppler procedure. Please share if you like the article.
References: