Examining 2023 Extremity Ultrasound Codes for Advanced Comprehension

As post-pandemic patient volumes pick up, it is important to review key procedures to ensure success with coding and compliance. Ultrasound procedures are an important area for patient diagnosis and are key to informing patient care and treatment. Diagnostic ultrasounds for extremities have seen some changes worth analyzing including the addition of a new code. Let’s review the codes to overcome challenges for reimbursement success.

Analyzing 76881–76882

76881	Ultrasound, complete joint (i.e., joint space and periarticular 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

Revenue Code: 0402

Coders must be careful to know that 76881 has some specific rules relative to examination. This code details a complete evaluation of a specific upper or lower extremity joint. Coders should note this code requires examination of all of the following:

• Joint space (e.g., effusion)
• Periarticular soft tissue structures surround the joint (i.e., muscles, tendons, other soft tissue structures)
• Any other identifiable abnormalities

With this code, in particular, there are some conditions and circumstances that may spell trouble for coders and compliance professionals. Under some scenarios, additional evaluations, such as dynamic imaging or stress maneuvers, may be necessary and are considered components of a complete evaluation. This evaluation may serve as a complementary or substitute exam (e.g., substitute for MR examination of the shoulder or ankle). The interpreting physician may participate in the exam by physically maneuvering the patient’s arm or leg in order to evaluate the scan.

It is imperative that a permanently recorded image is also acquired. This permeant image must be accompanied with a written report containing descriptions of all of the above-required elements, as well as reasons why any elements could not be captured.

One situation coders might grapple with is which code to report when all necessary elements for a complete exam are not performed. Under this scenario, coders must report 76882 for a limited exam. Code 76882 represents a limited evaluation of a joint or a focal evaluation of a structure(s) in an extremity other than a joint (e.g., soft tissue mass, fluid collection, or nerves).

Coders must be cautious when analyzing what this code encompasses. A limited evaluation of a joint includes an assessment of specific anatomic structure(s) but does not assess all of the elements required in order to assign code 76881. What type of evaluation does this code account for?

This may be an evaluation of:

• the joint space,
• tendons,
• muscles,
• or other soft-tissue structures around the joint.

Like the initial code, code 76882 also requires permanently recorded images and a written report describing the elements evaluated. These points are reiterated in Clinical Examples in Radiology, Volume 14, Issue 2, Spring.

Cracking into 76882 with a Case Study

Clinical indication: Leg pain. Concern for pseudoaneurysm in right inguinal after cardiac stent placed pain and bruising. Assess for pseudoaneurysm.

Comparison: None

Findings: There is no evidence of deep venous thrombosis in the right lower extremity. There is a 2 mm area of outpouching from the right common femoral artery which may be due to a small irregularity from prior procedure. It could also be related to atherosclerosis. A subjacent 3.8 x 0.6 x 1.7 cm hematoma is noted. No discrete pseudoaneurysm sac is identified.

Impression: No evidence of deep venous thrombosis.

There is a small area of outpouching from the right common femoral artery that does not lead into a saccular structure. This outpouching may be related to a catheterization type of procedure, or could be related to atherosclerosis with atherosclerotic ulceration. Continued sonographic follow and clinical follow-up may be considered.

There is a 3.8 x 0.6 x 1.7 cm subjacent hematoma which is presumably post-procedural in nature; again, this may be followed sonographically over time.

Analyzing Additional Tips for Less Common Scenarios

 Note that the evaluation of a mass within the soft tissues of the extremity is reported with code 76882. It is important to understand that code 76882 should not be reported with code 76883.

Ultrasound of the axilla when performed alone is reported with code 76882.

If spectral Doppler and a color imaging examination is medically necessary and performed, report additional CPT code 93925, 93926, 93930, or 93931. Note: If color flow Doppler is performed in addition to the ultrasound scan, ensure that the physician’s dictated report indicates why the Doppler was performed and what diagnostic information was obtained from it.

When medically necessary and when there are specific orders requesting the imaging of more than one joint in the same extremity, code 76881 or 76882 may be reported for each joint examined. Note: Closely review current CCI information for these codes if considering billing multiple units. Current CCI edits show that the MUE is 2 for each of these codes. The MAIs for these codes is 3.

A Glimpse of New Code 76883

76883

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

Coders must understand that in order to assign code 76883, a comprehensive evaluation of a nerve must be performed. How exactly is this defined? This is defined as the evaluation of the entire course of a nerve throughout an extremity. Coders should be careful to know that this code requires some specifically different elements as opposed to the older established codes. This includes the acquisition and permanent archive of cine clips and static images demonstrating the anatomy to be documented in the report in order to assign this code.

This is not all the knowledge necessary for correct and compliant ultrasound coding. As service volumes rebound, now more than ever, it is imperative to make sure your CPT® coding is correct and compliant. Purchase our nationally renowned Ultrasound Coder for full coding education coverage in 2023.