Ultrasound Elastography: What is it? What’s new? What do we need to know for coding?

One way to assess an area or organ for the presence of, or status of, a disease is the ‘old-fashioned’ way – via palpitation to see how it feels, i.e., how stiff or elastic the area is. To go beyond the boundaries of physical touch in a noninvasive manner, ultrasound elastography has been gaining clinical popularity.

Ultrasound elastography can be used to noninvasively determine the degree of fibrosis in a specific area or organ by applying stress and detecting the amount of tissue displacement using ultrasound imaging. Most commonly, this has been used to assess characteristics of lesions in the breast, thyroid and liver. Effective January 1^st, 2019 three CPT® codes were introduced for reporting ultrasound elastography:

76981    Ultrasound, elastography; parenchyma (e.g., organ)

76982    Ultrasound, elastography; first target lesion

+76983  Ultrasound, elastography; each additional target lesion (List separately in addition to code for primary procedure)

When comes to reporting these codes, there are some important points to be aware of:

1. Code 76981 is to be reported when an organ is being evaluated versus specific lesions being targeted for evaluation and can be reported once per organ. If an organ is being evaluated along with lesions within that organ, 76981 would still be the appropriate code to report and, again, only once.
   
2. If the study is only to evaluate specific lesions within an organ, then 76982 would be the appropriate code to report for the first lesion and add-on code +76983 for any additional lesions. This add-on code may only be reported a maximum of twice per organ, regardless of the number of lesions evaluated. So, even if 5 total lesions were targeted and evaluated in the liver it would only be appropriate to report code 76982 once and +76983 twice.
   
3. Current CCI edits from the Centers for Medicare and Medicaid Services (CMS) prohibit the coding of both a regular ultrasound and ultrasound elastography together at the same session, which is contradictory to other industry guidance. If performed at a separate session, the ultrasound and ultrasound elastography can both be coded but beware as CMS is keeping watch for services that should have been performed together being split for billing purposes. If these services are performed at separate sessions, ensure the documentation and orders for both do support separate sessions.

Finally, and possibly most importantly, is the need to check with payers for their coverage policies prior to submitting these codes. Currently, there are payers that consider ultrasound elastography to be a non-covered service. Stay tuned and be aware of updates to those policies as use of ultrasound elastography continues to expand.

With rapid advancements in technology, it can be difficult to be able to keep up with current trends, new services and techniques plus the codes and guidelines that go along with them. We can help you with that, the Ultrasound Coder is designed to be a quick, easy-to-use reference organized by body system to quickly answer questions and determine accurate codes for both diagnostic and interventional procedures.