Basics of Liver Biopsy CPT code
Coding for a biopsy depends on many factors, such as the type of biopsy sample (eg, fine needle aspiration [FNA] or core needle biopsy), the number of lesions biopsied, and whether imaging guidance was used. Imaging guidance is used to ensure exact location for needle placement—and is usually separately reported based on the imaging modality (eg, fluoroscopy, ultrasound, CT, or MR imaging). Imaging guidance is not included in CPT code 47000 and, therefore, imaging guidance code is separately reported.
A contrast-enhanced ultrasound performed in conjunction with an ultrasound-guided core liver biopsy is appropriately reported with Current Procedural Terminology (CPT®) code 76978 for the contrast-enhanced ultrasound, CPT code 76942 for the ultrasound guidance of the liver biopsy, and code 47000 for the liver biopsy.
Contrast-enhanced ultrasound is a procedure that uses dynamic microbubble contrast administration with ultrasound imaging to evaluate lesions. Usually, the lesion(s) involved was previously identified but not fully characterized on a prior image or examination. Contrast-enhanced ultrasound results in better visualization of lesions, allowing more accurate diagnostic characterization.
If multiple lesions are biopsied during the same session using this technology and additional doses of contrast are needed for lesion characterization, it is appropriate to report code 76978 for the initial lesion, and add-on code 76979, Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (List separately in addition to code for primary procedure), for each additional lesion.
It is important to note that code 76979 can only be reported if a separate contrast injection is performed on each additional lesion. Codes 76978 and 76979 are reported once per lesion, regardless of how many injections are performed for the single lesion.
Note that a diagnostic ultrasound study requires a separate interpretation and report. It is suggested that each study be completely dictated in separate reports or dictated under separate headings within one report.
Description of Liver biopsy CPT codes
47000– Biopsy of liver, needle; percutaneous
76942 – Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
76978 – Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion
The ultrasound guidance used during the core liver biopsy is reported with code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation. Code 76978, Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion, should be reported to describe targeted dynamic microbubble sonographic contrast evaluation.
If a contrast-enhanced ultrasound (CEUS) and ultrasound guidance are needed to perform an ultrasound-guided core liver biopsy, it is appropriate to report procedure codes 76978 and 76942, in addition to code 47000, Biopsy of liver, needle; percutaneous. If two or more lesions are evaluated at the same imaging session, report CEUS for each additional lesion using code 76979, Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (List separately in addition to code for primary procedure). Code 76979 may only be reported if a separate contrast injection is performed on each additional lesion.
Note that a diagnostic ultrasound study requires that a separate report be provided; therefore, it is recommended that each study should be dictated in separate reports or under separate headings within one report.
Sample report for Liver biospy CPT code
Focal liver lesions.
Prior ultrasound, computed tomography (CT), and magnetic resonance (MR) studies.
Following signed consent and universal procedure, ultrasound of the liver was performed, focusing on the right liver. Correlation was made with the previous ultrasound, CT, and MR studies. Three previously identified focal areas of mildly increased echogenicity in the right liver were localized sonographically. A total of 2.5 mL of ultrasound contrast was injected intravenously while continuous ultrasound examination of these areas was performed. Intense contrast enhancement and washout of these two lesions were identified, consistent with malignancy.
Subsequently, the overlying skin was prepared and draped for biopsy. The skin and intercostal soft tissues were infiltrated with lidocaine. Under ultrasound guidance, a 17-gauge, coaxial, biopsy-guide needle was advanced into one of the lesions. The stylet was replaced with an 18-gauge biopsy gun. The biopsy gun was advanced into the lesion and a total of four core needle biopsy specimens were obtained. Tissue samples were sent to the pathology department for histologic evaluation. The needle was removed. Hemostasis was obtained. No complications were detected.
Contrast-enhanced, ultrasound-guided, percutaneous core needle biopsy of liver mass.
CPT codes
47000 Biopsy of liver, needle; percutaneous
76978 Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
Q9950 ×3 Injection, sulfur hexafluoride lipid microspheres, per mL
ICD-10 Code – K76.89 Other specified diseases of the liver
Healthcare Common Procedure Coding System (HCPCS) level II supply code Q9950, Injection, sulfur hexafluoride lipid microspheres, per mL, is reported for the contrast agent (sulfur hexafluoride lipid microspheres) used for the contrast-enhanced ultrasound evaluation. Note that code Q9950 is reported per milliliter administered; therefore, based on the report, it is reported as three units for the 2.5 mL used.
Reference: American Medical Association and American College of Radiology.
