Coding Ultrasound services

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fjohnson
Posts: 59
Joined: Wed Mar 13, 2013 9:04 am

Tue May 15, 2018 3:52 pm

What are the guidelines for coding an ultrasound when the order is for a limited ultrasound (76775) but the documentation supports a complete ultrasound (76775)? Please send a link to your reference.
Bill_Wong
Posts: 11
Joined: Fri Apr 13, 2018 11:54 am

Tue May 15, 2018 4:10 pm

Hi FJohnson,

This excerpt may apply to your situation.


Taken from Medicare Benefit Policy Manual, Ch. 15:

80.6.4 - Rules for Testing Facility Interpreting Physician to Furnish Different or Additional Tests (Rev. 80; Issued: 11-11-08; Effective: 01-01-03; Implementation: 11-19-07)

The following applies to an interpreting physician of a testing facility who furnishes a diagnostic test to a beneficiary who is not a hospital inpatient or outpatient. The interpreting physician must document accordingly in his/her report to the treating physician/practitioner.

Test Design
Unless specified in the order, the interpreting physician may determine, without notifying the treating physician/practitioner, the parameters of the diagnostic test (e.g., number of radiographic views obtained, thickness of tomographic sections acquired, use or non-use of contrast media).

Clear Error
The interpreting physician may modify, without notifying the treating physician/practitioner, an order with clear and obvious errors that would be apparent to a reasonable layperson, such as the patient receiving the test (e.g., x-ray of wrong foot ordered).

Patient Condition
The interpreting physician may cancel, without notifying the treating physician/practitioner, an order because the beneficiary’s physical condition at the time of diagnostic testing will not permit performance of the test (e.g., a barium enema cannot be performed because of residual stool in colon on scout KUB; 170.5PA/LAT of the chest cannot be performed because the patient is unable to stand). When an ordered diagnostic test is cancelled, any medically necessary preliminary or scout testing performed is payable.
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Bill Wong, CHC, CHPC, CCS, CPC, CPMA, CDEO
Corporate Compliance Analyst
Seattle Children's Hospital
Seattle, WA
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