Radiology Question for the Week of June 28, 2021

Radiology Compliance Question of the Week

Question:

I am confused about an answer regarding an ultrasound arthritis survey. It has been stated that when multiple joints are imaged ipsilaterally by ultrasound to report an unlisted code. However, if the physician completes 76881 bilaterally questioning arthritis, that would be 76881-50 or RT, LT, because it is not ipsilateral. Is that your understanding as well? Is there more information that you would have on the issue that you could direct me to?

Answer:

The unlisted code for US arthritis survey is used when multiple joints are requested at the same session, whether ipsilateral or bilateral, such as bilateral hands, bilateral feet, bilateral wrists, and bilateral ankles, all requested at the same time for arthritis, or it could be unilateral hip, knee, ankle, feet. This would be analogous to a bone survey but done with ultrasound instead of an x-ray. It is generally not going to be used when just the ankles or just the hips are ordered, even if the diagnosis is arthritis. Your diagnosis will often be rule/out arthritis. Code 76881 is reported for complete imaging of a single joint. The Winter 2015 issue of Clinical Examples in Radiology included a sample case with an ultrasound of multiple joints for arthritis. Part of the discussion included the following: “In addition, the report describes an ultrasound extremity survey to evaluate for arthritis in multiple joints. The use of code 76881, Ultrasound, extremity, nonvascular, real-time with image documentation; complete, and code 76882, Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific, multiplied by the number of joints evaluated is inappropriate. Therefore, unless a new code or series of codes for an ultrasound extremity survey study is created, this type of extremity survey should be reported with code 76999, Unlisted ultrasound procedure (e.g., diagnostic, interventional).”


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