Would it be correct to charge 76882 twice for ultrasound bilateral extremity non-vascular hip, knee, and ankle for joint effusion? I have one that was charged X6.


If bilateral exams of a particular joint such as hip or ankle were performed, then you can assign code 76881 or 76882 x 2 (or once with modifier 50). However, the American Medical Association and American College of Radiology have said that the ultrasound extremity codes are not really intended for use when multiple joints are imaged such as a survey for arthritis.
Clinical Examples in Radiology, Winter 2015, had a test case where bilateral hands (metacarpophalangeal joints), wrists, feet (metatarsophalangeal joints), and ankles were imaged by ultrasound for suspected arthritis due to pain. The discussion included the following:
“The use of code 76881, Ultrasound, extremity, nonvascular, real-time with image documentation; complete, and code 76882, Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific, multiplied by the number of joints evaluated is inappropriate. Therefore, unless a new code or series of codes for an ultrasound extremity survey study is created, this type of extremity survey should be reported with code 76999, Unlisted ultrasound procedure (eg, diagnostic, interventional.”


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