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Coding guide for Bladder, Gallbladder, Liver Ultrasound CPT code

In Radiology facility, one CPT code can be used for multiple organs or anatomic site. As we know radiology CPT codes falls under 7000 and 9000 series. We have already learnt about CT, MRI, ultrasound CPT codes here. But, still some of medical coders get confused in coding either MRI or ultrasound CPT codes. For example, if we have to code for gallbladder, liver or urinary bladder ultrasound cpt code, we might get confused with 76705 or 76775. Same happens with MRI cpt codes, we might get confused with non-joint (hand, toe, tibia, ulna, radius, fibula) and joint (elbow, shoulder, knee, hip, ankle) CPT codes. So, let us try to clear our doubts about these topics to avoid doing errors in future.

Coding guide for Bladder, Gallbladder, Liver Ultrasound CPT code

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Gallbladder or liver Ultrasound CPT code

For coding abdominal ultrasound procedure code, we have two CPT codes 76700 and 76705. For complete ultrasound we should check for all the eight organs gallbladder, liver, common bile duct, two kidneys, aorta, Inferior Vena cava (IVC), pancreas and spleen. Now, if all these organs are present you can go ahead and code CPT code 76700. And if one of the eight organs is missing you should report with CPT code 76705. Also, abdomen is divided into four quadrants – right upper, right lower, left upper and left lower. Here, also for each particular quadrant you can code limited ultrasound CPT code 76705.  So, you have to follow the below coding guideline for coding CPT code 76700 and 76705.

Complete Ultrasound for Abdominal (all eight organs present) 76700

Limited Ultrasound 76705 (for single organ, quadrant or less than eight organs of abdomen)

CPT code for gallbladder ultrasound

CPT code for liver ultrasound

CPT code for spleen ultrasound

CPT code for pancreas ultrasound

CPT code for Inferior vena cava ultrasound

CPT code for aorta ultrasound

Read also: learn when to code Ultrasound guidance CPT code 76942

Renal and urinary bladder ultrasound CPT code

Like ultrasound, we have two CPT codes for complete (76770) and limited ultrasound (76775) for renal exam. But, here two kidneys are common in abdominal and renal exam. Hence, here we should remember, retroperitoneal CPT codes 76770 and 76775 are applied only for two kidneys and urinary bladder. Now, when to report complete and limited renal ultrasound CPT codes

When there is presence of two kidneys, urinary bladder and renal diagnosis, you can go ahead and report complete retroperitoneal or renal ultrasound CPT code. If any one thing is missing out of these three criteria, you can code the limited renal exam CPT code 76775.

Medical coding example for Gallbladder Ultrasound CPT code

US/US GALLBLADDER-BILIARY (RUQ)

CLINICAL DATA:  Elevated liver enzymes

EXAM:

US ABDOMEN LIMITED – RIGHT UPPER QUADRANT

FINDINGS:

Gallbladder: Within the gallbladder, there is a 5 x 3 mm echogenic focus along

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the wall which neither moves nor shadows. A second 4 x 3 mm

echogenic focus which neither moves nor shadows is seen. A third

focus measuring 5 x 3 mm is also seen which neither moves nor

shadows. There are no echogenic foci which move and shadow as is

expected with gallstones. No gallbladder wall thickening or

pericholecystic fluid. No sonographic Murphy sign noted.

Common bile duct:

Diameter: 5 mm. There is no intrahepatic or extrahepatic biliary

duct dilatation.

Liver: No focal lesion identified. Liver echogenicity is overall mildly

increased.

IMPRESSION:

There are 3 echogenic foci in the gallbladder, largest measuring 5

  1. These foci are felt to represent polyps. Given this finding, a

followup study in approximately 1 year to assess for stability would

be advisable. No echogenic foci which move and shadow as is expected

with gallstones seen. No gallbladder wall thickening or

pericholecystic fluid.

Increased liver echogenicity is most likely indicative of a degree

of hepatic steatosis. While no focal liver lesions are identified,

it must be cautioned that the sensitivity of ultrasound for focal

liver lesions is diminished in this circumstance.

CPT – 76705 (only 3 organs)

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Medical coding example for Renal Ultrasound CPT code

US/US RENAL

CLINICAL DATA:  Hydronephrosis noted on prenatal scan ; patient is

now 10-day-old and here for follow-up exam

EXAM: RENAL / URINARY TRACT ULTRASOUND COMPLETE

COMPARISON:  None in PACs

FINDINGS: Right Kidney: Length: 4.7 cm..  There is moderate hydronephrosis..

Left Kidney: Length: 5.3 cm.  There is moderate hydronephrosis.

Bladder: The urinary bladder contains echogenic mobile layering debris.

Bilateral ureteral jets are observed.

IMPRESSION: There is moderate bilateral hydronephrosis. Bilateral ureteral jets

are visualized. There is echogenic mobile debris within the urinary bladder.

CPT – 76770 (two kidneys, bladder and renal diagnosis)

Hope, this coding guide will clear all confusion in coding ultrasound CPT codes for renal and abdominal region. Please do share this article if you liked it.

 

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