Medical Coding Training: Emergency Ultrasound Coding and Reimbursement


You're looking at the abdominal ultrasound. The more common thing you would look for in the abdominal ultrasound more common than not would be the gallbladder. Read this medical coding training article for more.

So in the right upper quadrant, you're looking there - you're looking for gallstones. You're looking for thickening of the gallbladder wall. You're looking for fluid around the gallbladder. All those indicate the potential for cholecystitis or inflammation of the gallbladder. And certainly, gallbladder stones would also be very helpful.

That once again, you would use medical coding option 76705. So when you see somebody mentioning gallbladder ultrasound, they're going to have a limited ultrasound of that area. They will really talk about the gallbladder. You might also look at the liver though for liver metastasis. They will sometimes show up in an ultrasound.

It's not as good as a CAT scan but seeing a tear in the liver not nearly is common. A CAT scan will show it at much remarkably greater than the ultrasound. So more than likely, you would be looking at the gallbladder if it was none post-traumatic ultrasound.

On the retroperitoneal area which is 76775, you'd look for, you know, you remember your kidneys or your retroperitoneum but so is your aorta. So we're looking where regular medical evaluation of abdominal pain, you should be looking for a triple A or an aortic aneurysm. And the common related for that would call for your use of the limited ultrasonography which would be more in a retroperitoneal position which would be 76775, as per the medical coding rules. So once again, that would be a difference between the other one.

You are going pelvic ultrasounds, if you know that you're evaluating a pregnant or potentially pregnant individual. That would mean of course a positive pregnancy test.

Pregnancy tests are very easy to do. They're done in less than a minute. Actually, they're done in about a minute where you put urine on. These are very accurate compared to earlier times. They were very inaccurate then but they're very accurate now. And if you're doing an ultrasound following a positive pregnancy test, you would be using an obstetrical ultrasound codes and 76815. What you'd be looking for would be fetal heart beat, placenta location, fetal position. Those would be not uncommon.

You would also be looking for, you know, things, you know, obviously if you're obstetrical it doesn't mean you can't have something in a tube too with other pregnancy tests. So once again, you would use the obstetrical with the positive pregnancy test or if someone you already knew was pregnant.

Non-obstetrical would be 76857. You'd be looking for things like ovarian cysts, uterine fibroids, pelvic fluid. You know, pelvic fluid could be from a big PID or a start of a tumor or an abscess as an example. But those of you what you'd use is 76857.

You guys and emergency medicine, there are two others that we utilize, one is vascular access. You will see this more and more by the way. A lot of physicians use this not only to do - to put in their non-tunnel catheters. This is very common. You will use it for an internal jugular, use it for femoral vein. You can use it for subclavian but not as common. And you would also use it for peripheral lines.

So if you put an external jugular in under the guidance of the ultrasonography, you would still use the same code of vascular access which is 76937. My guess, you're going to see it a lot more in the next couple of years. It's very, very nice to have that, to be able to get those needles in.

And the final thing is needle placement for peritoneal synthesis or a (tubal) synthesis if I'm going to put a needle and a catheter into somebody's abdomen to drain up acidic fluid or into somebody's chest to draw out pleural fluid, you would use a 76942. Once again, that's not uncommon in medical coding and billing.

Medical coding guidelines: Remember that with these codes, you would obviously use the -26 modifier whenever you're billing any of these. You do not need though for EKG interpretations. Or if you have the isolated rhythm strip interpretations, you do not need to add the -26 modifier, but you do for x-ray interpretations and for ultrasound interpretation. You do not need to use a -25 modifier with the E/M code when you're billing for these services.

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