CPT codes are essential for getting reimbursed for medical services like a liver ultrasound. If you want to bill an insurance company for an ultrasound, you’ll need the right CPT code. If your doctor orders an ultrasound of your liver, the hospital or clinic will use a CPT code to bill for the service.
This article will focus on the CPT codes you’ll need for liver ultrasounds, especially liver elastography.
Using the correct CPT code is essential for compliance and avoiding claim denials. Let’s dive in.
CPT Codes for Liver Elastography
When it comes to coding for liver elastography, you’ll generally be choosing between two codes: 91200 and 76981. The one you select depends on whether the procedure includes imaging or not.
Key Differences Between 91200 and 76981
- CPT code 91200: Elastography, without imaging. This code is for elastography procedures where they measure the stiffness of the liver without watching what they’re doing in real time.
- CPT code 76981: Ultrasound, elastography, parenchyma. Use this code when the elastography is performed with concurrent imaging, like B-mode ultrasound. This means the person performing the procedure can see the liver tissue as they’re assessing it.
Choosing the Correct Code
The key to selecting the correct code is determining whether the elastography device uses imaging (B-mode) or not. If it does, you’ll use 76981. If it doesn’t, you’ll use 91200.
If you’re not sure, you can check the device’s FDA clearance documentation to confirm the imaging mode. It’s also worth checking what the device manufacturer recommends. A few devices use B-mode imaging, so you’ll want to be sure you’re using 76981 for those.
Common Billing Mistakes
Billing for liver elastography can be tricky. Here are some common mistakes to avoid:
- Using the wrong CPT code. It’s easy to choose the wrong code if you’re not careful about the type of imaging your device uses. For example, some people mistakenly bill 91200 when the device uses B-mode imaging (which requires code 76981). This leads to claim denials and incorrect payments.
- Poor documentation. If your paperwork isn’t complete or clear, you’re more likely to have errors. Be sure to document why the test was medically necessary and your clinical interpretation of the results.
- Not following payer guidelines. Medicare, Medicaid, and private insurers all have their own rules. You need to stay up-to-date on what each payer requires to avoid claim denials.
Best Practices for Documentation and Compliance
Submitting accurate and complete documentation is a must when you’re billing for medical procedures. Here are some tips for making sure you’re in compliance.
Complete and Accurate Documentation
Your documentation should include:
- The date of the procedure
- What kind of elastography was performed
- Which device was used
- A clear statement of the imaging method, including whether B-mode imaging was used (this can help justify the use of CPT code 76981)
- A detailed interpretation of the elastography results, along with any findings
Compliance with Payer Guidelines
To ensure your claims are paid, it’s important to:
- Follow Medicare and Medicaid billing guidance and adhere to the latest CMS guidelines for liver elastography billing.
- Check with each payer organization to verify their reimbursement policies and documentation requirements.
Staying Updated
Medical coding can be complex and is constantly evolving. It’s a good idea to:
- Regularly consult coding resources like the ACR Ultrasound Coding Guide.
- Stay informed about any updates or changes to CPT codes and billing guidelines.
Key Takeaways
Coding correctly for liver elastography depends on understanding the difference between CPT codes 91200 and 76981 and choosing the one that reflects the imaging capabilities used during the procedure.
To get reimbursed, you’ll need to document the procedure thoroughly and follow payer guidelines carefully.
Coding updates and payer policies change frequently, so it’s important to stay up-to-date. Keeping current helps ensure accurate billing and reduces the chances that your claims will be denied. By remaining informed and vigilant, you can navigate the complexities of CPT coding for liver ultrasound and receive appropriate reimbursement for your services.