Radiology Question for the Week of April 11, 2016

Question:

Is there a CPT code to charge for ultrasound lymph node mapping other than 76536 (ultrasound thyroid) since the lymph node mapping takes a little more time than a thyroid? Below is an example of why we believe there should be a different code.

Exams can be done pre- and post-thyroidectomomy. US of the thyroid bed and mapping of the lymph nodes of the neck.  All compartments of the anterior and lateral aspects of the neck from the angles of the jaws to the sternal notch and laterally to each sternocleidnomastoid muscle are performed.  The range of lymph nodes can range from 20 to 70 or higher provided both sides of the neck are scanned.  The larger ones are measured.

Answer:

What you describe does sound like it should be assigned code 76536. If the procedure performed is extensively greater than what you might typically use this code for, and you are doing professional fee billing, modifier -22 (increased procedural services) could be appended to the code. When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required). Note: This modifier should not be appended to an evaluation and management (E&M) service and is not allowed for Medicare outpatient hospital billing (i.e., ambulatory payment classifications [APCs]).

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