Ultrasound Question for the Week of October 3, 2016



I have been asked for coding help for a new diagnostic ultrasound procedure: liver ultrasound with injection of LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension contrast. For the radiologist to bill for his or her services in the hospital setting, do you recommend assigning only the following code?

76705 Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up)

For the office place of service, do you recommend the above (76705) in addition to the following technical codes:

96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
Q9950 Injection, sulfur hexafluoride lipid microspheres, per mL



The above would be correct. Most of the time, a limited abdominal ultrasound will be performed, so 76705-26 would be appropriate for the radiologist to bill for the interpretation. It is possible that the contrast-enhanced imaging could be done as part of a complete abdominal ultrasound, and in that case 76700-26 (ultrasound, abdominal, real time with image documentation; complete) would be reported instead of 76705-26.

The hospital will bill Q9950 per mL and 96374 in addition to the technical component of 76705 or 76700. Code Q9950 has pass-through status under the hospital outpatient prospective payment system (OPPS), so the hospital will receive additional payment.

When performed in a physician’s office, the physician would report all three codes: 76705 (or 76700), Q9950 (per mL), and 96374. Some payers may not allow 96374 in this situation, but we do recommend that you report it unless you have specific instructions from the payer otherwise. Don’t forget to bill any discarded contrast with the JW modifier.

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

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

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



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.