Basics of CPT code 76881 and 76882
Their are many codes in radiology facility which are divided as completed and limited category. For example, the ultrasound abdomen has completed ultrasound (cpt code 76700) and limited US abdomen (CPT code 76705) codes. The complete abdomen exam included all the eight organs while limited abdomen exam is reported for less than 8 organs reported in medical report . Similarly for soft tissue US extremity we have to two codes as completed (CPT code 76881) and Limited (CPT code 76880).
CPT code 76881 represents a complete evaluation of a specific joint in an extremity. Code 76881 requires ultrasound examination of all of the following joint elements: joint space (eg, effusion), peri-articular soft-tissue structures that surround the joint (ie, muscles, tendons, other soft-tissue structures), and any identifiable abnormality. In some circumstances, additional evaluations such as dynamic imaging or stress maneuvers may be performed as part of the complete evaluation. Code 76881 also requires permanently recorded images and a written report containing a description of each of the required elements or reason that an element(s) could not be visualized (eg, absent secondary to surgery or trauma).
Code 76882 represents a limited evaluation of a joint or focal evaluation of a structure(s) in an extremity other than a joint (eg, soft-tissue mass, fluid collection, or nerve[s]). Limited evaluation of a joint includes assessment of a specific anatomic structure(s) (eg, joint space only [effusion] or tendon, muscle, and/or other soft-tissue structure[s] that surround the joint) that does not assess all of the required elements included in 76881. Code 76882 also requires permanently recorded images and a written report containing a description of each of the elements evaluated.
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Old description of CPT code 76881 and 76882
Ultrasound of the extremity is a non-invasive imaging technique that uses high-frequency sound waves to evaluate the extremities (arms and legs), providing real-time, two dimensional images.
CPT code 76881 – Ultrasound, extremity, nonvascular, real-time with image documentation; complete
CPT code 76882 – Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific
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Community Health Integration (CHI) New G code: G0019 & G0022
Description of CPT code 76881 and 76882
The new description will include the complete and limited exam of joint space and peri-articular soft tissue structure. As you can see the below description, CPT code 76881 exam includes the joint space and the surrounding soft tissues. While CPT code 76882 is a limited exam which involves a joint space or surrounding soft tissues such as tendons or nerves.
Below is the revised CPT code description with the deleted one.
- 76881 Ultrasound, complete joint (ie, joint space and peri-articular soft tissue structures), real-time with image documentation,
- 76882 Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation,
Now, the medical coders have to differentiate between the completed and limited ultrasound exam of extremity. Below is the definition for complete and limited ultrasound.
A complete ultrasound examination of an extremity (76881) consists of real time scans of a specific joint that includes examination of the muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality. It is not necessary to image the entire extremity with every diagnostic study.
A limited examination of an extremity (76882) would be performed primarily for evaluation of muscles, tendons, joints, and/or soft tissues. This is a limited examination of the extremity where a specific anatomic structure such as a tendon or muscle is assessed. (i.e., Trapezius and/or Sacroiliac Joints )
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Use of CPT code 76883
Description : Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity.
CPT code 76883 is created to report Ultrasound nerve exams for extremity. This code is reported for per extremity hence it should be reported only for single extremity using RT or LT modifier for unilateral exam.
Code 76883 was created to report comprehensive ultrasound of nerve(s) and accompanying structures throughout their entire anatomic course, which may include one or more joints in one extremity, including real-time cine imaging with image documentation. It should be noted that nerves may also run through tissues not associated with a joint. Report code 76883 once for each extremity.
A patient who experiences symptoms of altered sensation, loss of reflexes, or weakness may be a candidate for a comprehensive nerve ultrasound described by code 76883. This comprehensive ultrasound evaluates both the nerve(s) along its entire course and the surrounding structures because an injury could occur at any point along the length of the nerve. There should be a permanent record of the ultrasound examination and its interpretation.
ICD 10 codes used with Procedure code 76881 & 76882
The diagnosis codes for these procedures are mostly the soft tissue/superficial mass or lump of any specified location. We as medical coders, when their is no specified location, report the R22 series codes as Primary dx for 76881 & 76882 CPT code.
R22.0 Localized swelling, mass and lump, head
R22.1 Localized swelling, mass and lump, neck
R22.2 Localized swelling, mass and lump, trunk
R22.30 ‑ R22.33 Localized swelling, mass and lump, upper limb
R22.40 ‑ R22.43 Localized swelling, mass and lump, lower limb
R22.9 Localized swelling, mass and lump, unspecified
This exams are mostly performed in combination with breast ultrasound or diagnostic mammogram procedure codes.
Fees or Cost of 76881 & 76882 for Medicare
Based on the Medicare Physician Fee Schedule (MPFS), the national rate for complete ultrasound code 76881 is $104.04. That’s $32.40 for the professional component (26 modifier) and $71.64 for the technical component (TC modifier).
For limited code 76882, the reimbursement will of course be lower than for the complete code. The national rate for 76881 is $59.04, with $25.20 for the professional component (26 modifier) and $33.84 for the technical component (TC modifier).
Comparison: Here’s the difference between the national rates for the two codes:
- Global: $45.00
- Professional component: $7.20
- Technical component: $37.80
Their may be confusion to reported any soft tissue Ultrasound exam per other than extremity. But their specific code for all anatomic site. Below is the list of the appropriate ultrasound codes to report targeted exams based on the anatomic site evaluated.
Neck 76536
Upper Extremity 76881 or 76882
Axilla 76882
Chest Wall 76604-52*
Upper Back 76604-52*
Lower Back 76705
Abdominal Wall 76705
Nerves, peripheral 76882
Pelvic Wall 76857
Buttock 76857
Penis 76857
Groin 76882
Perineum 76857
Lower Extremity 76881 or 76882
Other Soft-tissue areas 76999
* Modifier 52 is used to indicate that less than a complete examination of the area (chest or back) was performed.