An extraordinary rise in the number of extremity ultrasounds in the last few years has brought one deletion and two additions to CPT that you need to know.
CPT 2011 replaces 76880 (Ultrasound, extremity, nonvascular, real-time with image documentation) with the following:
76881 — Ultrasound, extremity, nonvascular, real-time with image documentation; complete
76882 — limited, anatomic specific.
76882 point you to ‘specific anatomic structure’
Along with the just-in codes, CPT also added guidelines for 76881 and 76882 as was noted in the presentation.
The guidelines instruct that complete code 76881 includes real time ultrasound scans of a joint.
Complete: The guidelines teach that complete code 76881 includes real time ultrasound scans of a joint. In order to be complete, the documentation should reference related muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality.
Here’s an instance of a complete exam of the ankle, including the following:
Lateral structures (e.g, peroneus tendons; fibular ligaments)
Medial structures (e.g, posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons; deltoid ligament; neurovascular bundle)
Anterior structures (e.g, tibialis anterior tendon; ankle joint)
Posterior structures (e.g, Achilles tendon; retrocalcaneal and retroachilles bursa).
In contrast, limited study code 76882 applies to the examination of a specific anatomic structure, including 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 doctor needs to learn its cystic or solid characteristics.
Anticipate $9 to $85 difference in fees between codes
Change rationale: Code 76880 increased in use to quite an extent in the last few years. The AMA RUC Five-Year Review Identification Workgroup assessed the code use. Evidence proves that limited exams made up the majority of the increase. Since the work and practice expense differ greatly for complete and limited exams, CPT decided two separate codes would be a more precise way of identifying the services carried out.
The difference in work finds reflection 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 to quite an extent.
The national rate for global complete code 76881 is roughly $115, as per the 2011 Medicare Physician Fee Schedule. Global 76882 will bring in closer to $30, which is a difference of about $85.
The PC of 76881 should yield almost $29, and 76882 is somewhat lower, at about $20. As such if you do the math, you see that the TC fee for 76881 is about $86, while technical 76882 yields close to $10.
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