Basic of Abdomen Ultrasound CPT code 76700/76705

CPT code for abdominal ultrasound with doppler is very essential in medical coding. In medical coding, we have separate cpt codes for each anatomic location. Further, we have CPT codes for number of view or complete/limited exams. Here, also we will learn how to code the CPT code 76700 for abdominal ultrasound with doppler. The CPT code for abdomen is a direct code for complete (CPT code 76700) and limited exam(CPT code 76705). 

The coding for abdomen ultrasound depends on the number of organs studied. It happens when we code Doppler exam with ultrasound abdomen. We have separate code for limited and complete exam for Doppler as well. Ultrasound is used to help diagnose a variety of conditions, such as:

• abdominal pain or distention (enlargement)
• abnormal liver function
• enlarged abdominal organ
• kidney stones
• gallstones
• an abdominal aortic aneurysm (AAA)

How to reach out to CPT code 76700 for abdominal ultrasound

We have two CPT code for abdominal ultrasound, 76700 and 76705. The complete ultrasound of abdomen is codes 76700. The complete ultrasound of abdomen will include eight organs. The eight organs include gallbladder, common bile duct (CBD), liver, pancreas, spleen, inferior vena cava (IVC), aorta and two kidneys. When the exam is complete, we will have documentation of all the eight organs.

This complete ultrasound exam of abdomen leads to CPT code 76700. Abdomen is divided into four quadrants. Four quadrants are right upper quadrant (RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ) and left lower quadrant (LLQ). When the exams is limited to only one organ or quadrant of abdomen will lead to limited cpt code 76705. Since, we are limited the exam to only one organ or quadrant we will code ultrasound limited exam code. So, in short we are using following CPT codes for ultrasound abdomen

76700- Complete ultrasound of abdomen
76705- Limited Ultrasound of abdomen

Sometimes, the physician while performing the limited exam, he can perform complete ultrasound exam of abdomen. However, we are not allowed to code for complete exam even if eight organs are not documented. This kind of coding is up coding. If we code complete ultrasound of abdomen, we are billing more.

It is not appropriate to bill for both a retroperitoneal US study (76770/76775) AND a complete (or limited) abdominal US  (76700/76705)when a retroperitoneal US study is expanded to include organs and structures outside the retroperitoneum.

Read also: Best Coding guide for Lung Biopsy CPT code

Use CPT code 76700 for abdominal ultrasound with Doppler

Doppler is also refer as duplex in medical coding. The Doppler exam is generally performed on the vascular portion of abdomen area. The arterial and venous structure is examined while performing Doppler exam. Hence, while coding the abdominal ultrasound with Doppler we have to check for finding of both ultrasound as well as Doppler exam. If both the exam is done, we have to code as per their both RVU value and dollar value.

The Doppler exam generally includes the real time ultrasound exam. Therefore, while coding the cpt for Doppler and ultrasound we have CCI edit between them. Their is difference between in Ultrasound and duplex imaging techniques.

The American Medical Association provides the following definitions in the CPT guidelines for procedural terms related to ultrasound imaging:

• A-mode: This simplest form of ultrasound imaging is not frequently used. The ultrasound waves that come out of the ultrasound probe travel in a narrow, straight pathway.
• M-mode: Also known as measurement mode, this is a one-dimensional measurement procedure with movement of the scan to record the amplitude and velocity of moving, echo-producing structures.
• B-scan: This two-dimensional scanning procedure is the most common mode of ultrasound and is often used for anesthesia. The complete description of the mode is “real-time, two-dimensional, B-scan.” Two-dimensional refers to the fact that the image is horizontal (X-axis) and vertical (Y-axis).
• Real-time scan: This is a two-dimensional scan with a display of both two-dimensional structure and motion with time.
• Doppler mode: This mode makes use of the Doppler effect to measure and visualize blood flow.
• Duplex: A common name for the simultaneous presentation of two-dimensional and pulsed wave Doppler information. Using modern ultrasound machines, color Doppler is almost always also used.
• Three-dimensional fetal scanning: The ultrasound waves are sent straight down and reflected, then are sent at different angles. The returning echoes are processed by a sophisticated computer program that reconstructs a three-dimensional volume image of the fetus’s surface or internal organs, like CT scan images.

Doppler ultrasound images can help the physician to see and evaluate:

• blockages to blood flow (such as clots)
• narrowing of vessels
• tumors and congenital vascular malformations
• reduced or absent blood flow to various organs
• greater than normal blood flow to different areas, which is sometimes seen in infections

Read also: KickASS tips for Coding Modifiers in Medical Coding

CCI edit between ultrasound abdominal CPT code and Doppler exam

When we are coding CPT code for both ultrasound abdomen and Doppler ultrasound, we have CCI edit between them. Since, we know the ultrasound exam includes in the Doppler exam cpt code, we should use modifier to bill both Cpt. We can code both ultrasound and Doppler exam performed only with supported documentation.

If the exam says the Doppler exam was performed with ultrasound abdomen without any finding documented for Doppler we cannot code Doppler CPT code. The document should mention about arterial and venous finding with spectral waveform recording. Then only we can go ahead and code Doppler CPT code. The following CPT codes are used for Doppler or duplex exam for abdomen region.

93975 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study
93976 limited study
93978 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study
93979 unilateral or limited study
93980 Duplex scan of arterial inflow and venous outflow of penile vessels; complete study
93981 follow-up or limited study

Now, when are having CCI edit between Doppler codes and ultrasound abdomen CPT Code 76700 and 76705, we use modifier 59 with ultrasound CPT Codes. Modifier 59 is used for distinct procedures. The ultrasound, which is included with Doppler exam, should not be code with Doppler exam. However, we have an ultrasound procedure performed separately with Doppler with supporting documentation we have to code them together.

When we bill them together without a 59 modifier, ultrasound abdomen CPT Code will not be paid. The simple reason is that ultrasound abdomen is included with Doppler. However, when we code ultrasound abdomen with 59 modifier along with Doppler exam CPT Code, both the procedures are paid. The simple reason is that modifier 59 with ultrasound abdomen modifies the code as distinct procedure. Hence, both procedures are paid. Therefore, we have to report with both ultrasound abdomen and Doppler exam with supported documentation for CPT code 93975/93976 with 76700/76705 with 59 modifier.

Related ultrasound CPT codes in Radiology

76856 Ultrasound, pelvic (nonobstetric), 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 (eg, 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 (eg, bladder tumor, enlarged prostate, free pelvic fluid, pelvic abscess).

76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (ie, for follicles)

This “limited” CPT code covers a focused examination in the assessment of 1 or more elements listed in the “complete” pelvic ultrasound CPT code 76856. Use this code if an ultrasound of the bladder only is performed but not to obtain a post voiding residual urine only. It also covers the reevaluation of 1 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 (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 instead.

Hope, now you can code the CPT code 76700 for abdominal ultrasound with Doppler exam after reading this article. If you like the article please share it.