subject: Extremity Ultrasounds: 76881 Brings in $85 More than 76882 [print this page] Extremity Ultrasounds: 76881 Brings in $85 More than 76882
Be careful of overcoding tendon or muscle scan
A significant increase in the number of extremity ultrasounds in the last several years brought about one deletion and two additions to CPT that you need to know.
This year CPT replaces 76880 (Ultrasound, extremity, nonvascular, real-time with image documentation) with:
76881
76882 --
76882 guidelines point you to 'specific anatomic structure'
Along with the just-in codes, CPT also added new guidelines for 76881 and 76882.
Complete: The guidelines tell you that complete code 76881 includes real time ultrasound scans of a joint. The documentation ought to reference related "muscles, tendons, joint, other soft tissue structures, along with any identifiable abnormality to be complete.
For instance: CPT Changes 2011: An Insider's View presents the case of a complete exam of the ankle, including all of the following:
Lateral structures
Medial structures
Anterior structures
Posterior structures
In comparison, limited study code 76882 applies to the examination of a specific anatomic structure, (inclusive of a muscle, tendon, joint, or other soft tissue).
Guidelines for 76882 also explain that the code is proper for evaluation of a soft-tissue mass if the physician needs to learn its cystic or solid characteristics.
Anticipate $9 to $85 difference in fees between codes
Change rationale: Code 76880 increased in use considerably in the last few years. The American Medical Association (AMA) RUC Five-Year Review identification workgroup assessed the code use. Evidence suggested that limited exams made up the bulk of the increase. As the work and practice expense differ to a great extent for complete and limited exams, CPT decided two separate codes would be a better and accurate way of identifying the services carried out.
The difference in work is shown in the rates for these just-in codes. Even though the professional rates are quite similar, the technical and global (professional plus technical) rates for these codes differ greatly.
According to Medicare Physician Fee Schedule, the national rate for global complete code 76881 is around $115. Global 76882 will bring in closer to $30, a difference of about $85.
The PC of 76881 should yield almost $29, and 76882 is slightly lower at about $20. As such if you do the math, you see the TC fee for 76881 is about $86, where as technical 76882 yields close to $10.
