Emergency Ultrasound Section Forum
Coding and Reimbursement
Billing and Coding Question 2015
Just wanted to get an idea of the EM programs that bill for their ultrasounds. Despite the recommendations in the Emergency Ultrasound Coding Guide update, I am still “disagreeing” with our chair of radiology about which codes we should be billing. He is putting up a lot of resistance over CPT code 76775 Biliary although this is the limited code used for focused Gallbladder. I tried to explain that this was not the complete abdomen but because it is a 76000 level code he does not think we should be billing it. I also pointed out that the 76705 code is used in the EFAST billing (he does not have an issue with billing for EFAST). I believe he is under the impression we are going to “steal revenue” from radiology. He is under the impression that the 76000 CPT codes are “radiology codes” only. I even showed him in the Emergency Ultrasound Coding and Reimbursement guidelines that all physicians regardless of specialty utilize the same CPT codes.
This leads me to two basic questions I was hoping I could get some feedback on:
1. Do you have a list of billing codes you use in your ED for ultrasound (so I can show what other place’s do and prove other places use the 76000 codes in ED)
2. How does your institution bill when the ED does a limited study, for example 76705 for a focused gallbladder and then order a complete abdomen 76700 from radiology. Do you bill both. I know the guidelines state that CMS will pay for the interpretation and report that directly contributed to the diagnosis and treatment (FAQ from the Emergency Ultrasound Coding and Reimbursement guidelines).
Just wondering how most places are doing it.
Appreciate the help!
Robert Strony DO, RDMS, RVT
Program Director, Emergency Medicine Residency
System Point of Care Ultrasound Director
Geisinger Health System
A very timely question. The 2014 list of CPT codes to bill for bedside ultrasound are posted on the ACEP website.
Go to the first tab on the left, "Clinical Practice & Management" and look for the heading "Resources" click on that. Then scroll down to the link for "Ultrasound" and click that. Then under the heading "Coding/Reimbursement Documents" click on the link for "Emergency Ultrasound Coding and Reimbursement."
We will be updating this document very soon with the newest changes for 2015, which came out just a few weeks ago.
You are correct these codes are not radiology specific and anyone can use these codes.
For your second question, per CPT it is allowable for 2 different physicians to report the limited and one for a complete exam of the same anatomic description as long as you document that the information/interpretation from the limited study requires that more complex testing is required and that testing is a complete ultrasound.
In reality, most payors will not pay for both a limited and a complete study because the complete study encompasses the limited study. The department that submits its bill first will get paid first and the second department's bill will get rejected. It is a good idea to plan ahead for these situations and decide if your department will submit a bill when a complete is necessary or not.
Stanley Wu, MD, MBA, RDMS, FACEP
Director of Ultrasound Operations, Emergency Medicine
Assistant Medical Director, Emergency Medicine
Ben Taub General Hospital Emergency Center
Assistant Professor, Baylor College of Medicine