Are you struggling to select the correct code for abdominal ultrasounds? Or are the similarities of abdominal and retroperitoneal ultrasound codes confusing you? You are not alone. Hundreds of billers make the same mistakes while filing radiology claims.
A particularly challenging code is CPT code 76705, which represents limited imaging. However, the line between 76705 and retroperitoneal ultrasound codes is blurry, leading to claim denials. That’s why our billing experts have included this 76705 CPT code guide in our ‘CPT Codes’ series.
So, let’s start and understand how you can use this code effectively.
CPT Code 76705 – Description
CPT code 76705 is officially defined as:
“Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up).”
As evident from the code description, 76705 is used to bill ultrasound imaging of the abdomen. However, its scope is limited to the visualization of only one organ or an anatomical quadrant. Moreover, the code is mostly used for focused follow-up studies.
CPT code 76705 provides real-time imaging of the focused area. You might ask what real-time imaging means. Well, it means that the ultrasound delivers immediate, dynamic images of internal body structures, allowing for the visualization of movement and changes as they occur. An example can be the ultrasound imaging that is used during pregnancy to view an unborn baby.
The code is designated a Status Indicator “A” under Medicare guidelines, meaning it is an active code and Medicare separately reimburses it under the Physician Fee Schedule.
Scenarios Where CPT Code 76705 is Applicable
The following are some scenarios in which CPT code 76705 can be used:
Kidney Issues
A 42-year-old female patient visits her primary care physician with a two-week history of left flank pain and intermittent hematuria (blood in urine). The woman also has a history of kidney stones. Before making a diagnosis, the physician orders some tests. The test results show elevations in serum creatinine and the presence of red blood cells in urine.
Given the patient’s history and test results, the physician performs a targeted ultrasound of the left kidney. The ultrasound shows kidney stones and the inflammation of the left kidney. The patient is referred to a urologist for treatment. Hence, the physician can bill the ultrasound with CPT code 76705 in this scenario.
Emergency Rooms
A frequent use of CPT code 76705 is in emergency departments. Let’s look at a practical scenario. Suppose a 55-year-old patient presents to the emergency department with upper right quadrant pain and vomiting. The physician performs a focused ultrasound examination specifically targeting the gallbladder and surrounding structures to rule out or confirm acute cholecystitis.
However, the ultrasound reports reveal gallbladder stones, which also cause gallbladder wall thickening and buildup of pericholecystic fluid (an indication of gallbladder inflammation). So, the physician suggests immediate treatment. This targeted assessment can be billed using code 76705.
Applicable Modifiers for CPT Code 76705
The following are some modifiers that can be used with CPT code 76705 when necessary.
| Modifiers | Description | Application with CPT 76705 |
|---|---|---|
| 26 | Professional Component | Used when billing only for the physician’s professional services, including image interpretation and report generation. |
| TC | Technical Component | Used when billing only for the technical aspects of the procedure (equipment, technician, supplies). |
| 52 | Reduced Services | Used when the service is partially reduced. |
| 59, X{EPSU} Modifiers | Distinct Procedural Service | Indicates the procedure was distinct from other services performed on the same day. |
| 76 | Repeat Procedure, Same Provider | Used when the same physician repeats the limited abdominal ultrasound on the same day. |
| 77 | Repeat Procedure, Another Provider | Used when another physician repeats the limited abdominal ultrasound on the same day. |
CPT Code 76705 – Billing & Reimbursement Guidelines
The following are some billing guidelines and essential points to consider for CPT code 76705 claim submissions.
Documentation Requirements
- Document the service with both images (technical component) and a written report (professional component) in the patient’s chart.
- If sonographers detect any abnormalities, thoroughly describe them, including their location, characteristics, and size.
- State if the images were analog (film) or digital (electronic).
- Include a permanent record of ultrasound examination and interpretation.
Billing Guidelines
- CPT code 76705 is used for limited abdominal ultrasounds that can include retroperitoneal views. However, you cannot bill separately for both abdominal and retroperitoneal exams performed in the same session.
- Imaging and evaluation and management (E/M) services performed on the same day should be separately documented and billed.
- The technical component (TC) should be billed by the facility that owns the ultrasound machine.
- An interpreting provider should bill the professional component (PC).
Reimbursement Tips
- The reimbursement amount for CPT code 76705 varies based on the modifier usage, MAC locality, and facility settings.
- The Medicare national average reimbursement amount for non-facility settings is $84.10.
- If only the technical component (modifier TC) is billed, the national average amount is reduced to $57.25.
- The professional components have a reimbursement rate of $26.85 in both facility and non-facility settings.
- You can check the exact amount for your MAC locality via Medicare’s PFS Lookup Tool.
Wrapping Up
Let’s wrap up everything. In this guide, we have provided a simplified explanation and usage guidelines for CPT code 76705. We also shared some scenarios in which this CPT code may apply.
If you are facing frequent claims denials or cannot generate the revenue you expect, try consulting billing experts. Third-party medical billing companies offer personalized and highly specialized radiology billing services that are known to reduce denials and increase collections.
