Chapter 15: Abdomen and Retroperitoneum (76700-76776)

CPT offers specific guidelines for the abdominal and retroperitoneal ultrasound section distinguishing limited studies
from complete. As detailed as the guidelines are, questions still come up when documentation doesn't quite fit the
options the guidelines give. Here's how to apply the guidelines to real-world situations.
Bring Limited and Complete Requirements into the Light
You have limited and complete options for abdominal ultrasound:

76700 Ultrasound, abdominal, real time with image documentation; complete

Complete: A complete ultrasound exam of the abdomen (76700) "consists of real time scans of the liver, gall bladder,
common bile duct, pancreas, spleen, kidneys, and the upper abdominal aorta and inferior vena cava including any
demonstrated abdominal abnormality," according to "Abdomen and Retroperitoneum" guidelines.

76705 ... limited (e.g., single organ, quadrant, follow-up)

Limited: Guidelines for the "Diagnostic Ultrasound" section state that "if less than the required elements for a
'complete' exam are reported (e.g., limited number of organs or limited portion of region evaluated)," you should
report the limited code once per patient per exam session.
For example, your best bet for an ultrasound of the right flank soft tissues is 76705.
The same "limited exam" rules apply to limited retroperitoneal ultrasound:

76775 Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited.

You have a separate complete code:

76770 ... complete.

Requirements: You need "real-time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior
vena cava, including any demonstrated retroperitoneal abnormality."
Exception: If the patient's clinical history suggests urinary tract pathology, you may code a complete exam for
complete evaluation of the kidneys and urinary bladder.
Flank pain (789.0x, Abdominal pain) is a good example of this sort of clinical history, in addition to all of the typical
urinary problems, such as dysuria (788.1, Dysuria) and frequency (788.4x, Frequency of urination and polyuria).
Bonus: For a complete exam, the "Diagnostic Ultrasound" guidelines state documentation must either describe all the
listed elements or give a reason why the radiologist couldn't visualize an element, such as "obscured by bowel" or
"surgically absent."
76775 or G0389: Verify Reason for AAA Ultrasound
For an ultrasound of the aorta to detect an abdominal aortic aneurysm (AAA), the radiologist most likely performed a

CPT 2014 American Medical Association. All rights reserved.

limited retroperitoneal ultrasound. CPT describes this procedure with 76775 (Ultrasound, retroperitoneal [e.g., renal,
aorta, nodes], real-time with image documentation; limited).
Watch out: If the patient was referred for a one-time AAA screening following an initial preventive physical
examination for Medicare and is included in one of the listed risk categories, you should report G0389 (Ultrasound Bscan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening).
The risk categories (patient must meet one) are the following:

Has a family history of abdominal aortic aneurysm

Is a man with age 65 to 75 who has smoked at least 100 cigarettes in his lifetime
Is a beneficiary who manifests other specified risk factors.

Tip: If the patient was not referred as part of the IPPE, you may need to follow up with the ordering physician's office
to see if the exam was truly performed for screening purposes or if the patient has signs or symptoms that suggested
AAA.
Key Concepts:
Eliminate Undercoding or Pay the Price
Protect yourself: If you undercode, you aren't being overpaid, so payers won't care, right? Wrong.
Consistent undercoding can get you in trouble the same as consistent overcoding.
If an auditor sees that you're consistently undercoding, she's going to wonder why.
The auditor will delve deeper into your charts to see, for example, whether you're using the wrong code to increase
your chances of getting paid for a particular procedure or to avoid a frequency cap.
The consequences: If a Medicare auditor finds you consistently undercoding, the contractor will likely make your
practice carve out some time for documentation and coding education. You may also face fines and penalties.
Communication with your doctors is crucial to correcting this problem.
Try this: Suppose the radiologist's documentation says, "complete abdominal ultrasound," but she doesn't comment
on the patient's gall bladder or spleen. You leave:

A note specifying exactly what you need clarified

A copy of the doctor's documentation
A copy of the AMA's CPT guidelines for abdominal ultrasound, which require discussion of the "liver, gall bladder,
common bile duct, pancreas, spleen, kidneys, and the upper abdominal aorta and inferior vena cava including any
demonstrated abdominal aorta."

You can also point out that if the documentation doesn't meet CPT guidelines for 76700
(Ultrasound, abdominal, real time with image documentation; complete), so that the coder is left with the only option
of reporting 76705 (limited [eg, single organ, quadrant, follow-up]) based on available documentation of the
performed procedure.
See CPT Guidelines on 76776
Ultrasounds of transplanted kidneys are nearly always performed with real-time imaging and Doppler, and CPT 2007
added 76776 (Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation) to reflect this
standard.

CPT 2014 American Medical Association. All rights reserved.

When you report 76776, you shouldn't report 93975 (Duplex scan of arterial inflow and venous outflow of abdominal,
pelvic, scrotal contents and/or retroperitoneal organs; complete study) or 93976 (... limited study).
If a physician performed the limited retroperitoneal US without duplex Doppler, you should report 76775 (Ultrasound,
retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited), according to CPT guidelines.

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.