Q&A: CPT reporting for ultrasound elastography services performed with additional ultrasound services
Q: Can you bill CPT codes 76981 (ultrasound, elastography; parenchyma [e.g., organ]) and 76982 (ultrasound, elastography; first target lesion) at the same time as CPT codes for liver and breast ultrasounds?
A: The American Medical Association introduced three new CPT codes, effective January 1, 2019, for elastography services: 76981, 76982, and add-on code 76983 (ultrasound, elastography; each additional target lesion; list separately in addition to code for primary procedure).
These CPT codes replaced a more generic Category III code 0346T (ultrasound elastography), which is now deleted. The new codes are used to report assessments for patients with diseases of solid organs, like the liver, or assessments of lesions within solid organs.
Specifically, elastography procedures are performed using ultrasound to measure the elastic properties of soft tissue, such as the parenchyma of an organ, or lesions within a soft tissue organ to assess organ parenchyma and focal lesions. The bulk of functional cells within an organ is parenchymal tissue. This imaging technique may be used to obtain diagnostic information regarding diseases of structures such as the liver, breast, thyroid, prostate, and muscles.
Several National Correct Coding Initiative (NCCI) procedure-to-procedure edits are linked to these codes to prevent the reporting of non-payable code combinations. Some CPT codes for elastography services, listed in the table below, should not be reported together for reasons explained in the NCCI Coding Policy Manual for Medicare Services:
Column 1
Column 2
Modifier Allowed?
76981
76982
Yes
76705
76981
Yes
76641
76981
Yes
76982
76642
Yes
76705
76982
Yes
- 76705, ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up)
- 76641, ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete
- 76642, ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited
Column 1 codes will be approved for payment. Column 2 codes will be denied when reported with a column 1 code. The third column indicates if an appropriate modifier can be appended to the column 2 code to bypass the edit so both codes can be reported when clinically appropriate.
Editor’s note: Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, partner at the American Regulatory Compliance Society, answered this question during HCPro’s webinar, “2019 CPT Update: Prepare for New Coding, Documentation Requirements.” This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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