HealthNow UMD
Article -- Coding Guidelines

Contractor Name
HealthNow

Contractor Number
00801

Contractor Type
Carrier

Article Database ID Number
A23205

Article Type
Article

Article Title
Abdominal Retroperitoneal Ultrasound - 4 End dated

Is the AMA CPT / ADA CDT Copyright Statement Required?
Yes

CPT codes, descriptions, and other data only are copyright 2007 American Medical Association (or such other data of publication of CPT). All Rights Reserved. Applicable FARS/DFARS clauses apply. Current Dental Terminology (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. (C) 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Primary Geographic Jurisdiction
Upstate New York

Article Publication Date
09/27/2004

Article Beginning Effective Date
10/01/2007

Article Ending Effective Date
05/15/2008

Coding Guidelines

   1.  The guidelines of the Correct Coding Initiative (CCI) supersede all
       coding instructions in this policy.

   2.  The complete study is to be used at a single session if:

       a.   The complete service as described above is performed

            or

       b.   multiple organs are visualized

            or

       c.   bilateral studies are performed

   3.  The limited study is to be coded when:

       a.   a single organ system is of interest

            or

       b.   a follow up to an initial study is being performed

            or

       c.   a unilateral study is being performed

   4.  An abdominal ultrasound (76700/76705) and a retroperitoneal study may
       be reimbursed on the same day.

   5.  Modifiers 26 (Professional component) and TC (Technical component)
       should be used if appropriate.

   6.  Diagnosis code must be present on all claims submitted and must be
       coded to the highest level of specificity.

   7.  Complete and limited studies will not be allowed on the same date of
       service.

   8.  The name and UPIN number of the referring/ordering physician or
       qualified non-physician practitioner must be reported in Items 17 and
       17a of the  CMS-1500 form, or NPI (when effective) in item 17b, or in
       the electronic equivalent, when submitting electronically.

   9.  The global procedure for codes 76770 and 76775 is payable in a school
       (03), homeless shelter (04), office (11), home (12), assisted living
       facility (13), mobile unit (15), urgent care facility (20), ambulatory
       surgical center (24), skilled nursing facility (31), nursing facility
       (32), custodial care facility (33), and independent clinic (49).

       The Technical Only component of codes 76770 and 76775 is payable in
       place of service home (12), assisted living facility (13), group home
       (14), mobile unit (15), nursing facility (32, and custodial care
       facility (33).

       The professional component of codes 76770 and 76775 is payable in an
       office (11), urgent care facility (20), inpatient hospital (21),
       outpatient hospital (22), emergency room (23), ambulatory surgical
       center (24), and independent clinic (49).

       Codes 76770 and 76775 are not ambulatory surgical center listed
       services.  The technical components of these codes are paid through
       Part A in places of service:  inpatient hospital (21) and outpatient
       hospital (22).

CPT/HCPCS Codes

    76770           Ultrasound, retroperitoneal (e.g., renal, aorta,
                    nodes), real time with image documentation; complete

    76775           ; limited

Other Comments
For services that exceed the accepted standard of medical practice and may be deemed not medically necessary, the provider/supplier should provide the patient with an acceptable advance notice of Medicare's possible denial of payment. An advance beneficiary notice (ABN) should be signed when a provider/supplier does not want to accept financial responsibility for the service.

This Article was converted from an LMRP on 09/27/2004. Place of service information was added to the Coding Guidelines, section #9.

Does this Article contain a "Least Costly Alternative" provision?
No

Revision History Explanation

This article is end dated because it is no longer an effective education tool.

Revision #4: Revised guideline #8 to reflect updated NPI information.

Revision #3: Revised descriptor of CPT code 76770. Added statement to clarify payable places of service for the TC only portion of 76770 and 76775.

Revision #2: LCD was updated with the new 2006 ICD-9-CM changes, effective for dates of service on and after 10/01/2005. No changes were made to the coding guideline article.

Revision #1: Added place of service home (12).