Ultrasound Question for the Week of November 7, 2016

Question:

Question:

I have conflicting information about coding for a liver ultrasound with LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension contrast. Do I bill 76705, 76700, or C9744?

Answer:

Answer:

All of those could be correct. The correct code for you depends on what insurance the patient has, whether you are billing for the facility or the physician, and when the exam was done.

If you are billing for a hospital based out-patient clinic (OPPS) and the exam was performed prior to October 1, 2016, you would report:

• Code 76705 for a limited abdominal ultrasound
• Code 76700 for a complete abdominal ultrasound

If you are billing for a hospital based out-patient clinic and the exam was performed after October 1, 2016, you would report:

• HCPCS Code C9744 for the abdominal ultrasound with contrast, for your Medicare patients
• Code 76705 (limited abdominal ultrasound) or code 76700 (complete abdominal ultrasound), unless the commercial payer provides you with instructions to use the HCPCS Code C9744

If you are billing for a non-hospital facility or for the interpreting radiologist, you would report:

• Code 76705 for a limited abdominal ultrasound or code 76700 if a complete ultrasound was ordered and performed.

• In all cases, the provider billing the technical component would also report Q9950 for LUMASON®. Code Q9950 is billed per mL and each vial contains 5 mL. Account for all product used and discarded for a total of 5mL.

Providers may also be able to report code 96374 for the administration of contrast. This code should not be reported by the physician for services provided in a hospital setting, but may be allowed by other payers.

LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension

INDICATIONS AND USAGE
LUMASON is an ultrasound contrast agent indicated for use:
• in echocardiography to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border in adult patients with suboptimal echocardiograms
• in ultrasonography of the liver for characterization of focal liver lesions in adult and pediatric patients

CONTRAINDICATIONS
LUMASON is contraindicated in patients with:
• Known or suspected right-to-left, bi-directional, or transient right-to-left cardiac shunts
• History of hypersensitivity reactions to sulfur hexafluoride lipid microsphere components or to any of the inactive ingredients in LUMASON

IMPORTANT SAFETY INFORMATION:

WARNING: SERIOUS CARDIOPULMONARY REACTIONS

Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following the injection of ultrasound contrast agents, including sulfur hexafluoride lipid microspheres [see Warnings and Precautions (5.1)]. Most serious reactions occur within 30 minutes of administration [see Warnings and Precautions (5.1)].

• Assess all patients for the presence of any condition that precludes administration [see Contraindications (4)].
• Always have resuscitation equipment and trained personnel readily available [see Warnings and Precautions (5.1)].

The risk for serious cardiopulmonary reactions may be increased among patients with unstable cardiopulmonary conditions (acute myocardial infarction, acute coronary artery syndromes, worsening or unstable congestive heart failure, or serious ventricular arrhythmias) [see Warnings and Precautions (5.1)].

Please see full Prescribing Information including boxed WARNING at http://imaging.bracco.com/us-en/lumason

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

LUMASON is manufactured for Bracco Diagnostics Inc., Monroe Township, NJ 08831 by BRACCO Suisse S.A., Plan-les-Ouates Geneve, Switzerland (Lumason lyophilized powder vial-25 mg lipid-type A/60.7 sulfur hexafluoride gas); Vetter Pharma-Fertigung GmbH & Co. KG, 88212 Ravensburg, Germany (Sodium Chloride, 0.9% Injection, USP); B. Braun Melsungen AG, 34212 Melsungen, Germany (Mini-Spike).

LUMASON is a registered trademark of Bracco Diagnostics Inc.