ED Coding and Reimbursement Alert

Question: Encounter notes indicate the ED physician treated a patient with contusions to his chest and abdominal wall. The physician performed a FAST exam and found "no pericardial fluid, no abdominal fluid," according to the report. I have never coded a FAST exam and cannot find the code anywhere in CPT. Can you help? Tennessee Subscriber Answer: There is no single code for a FAST (focused abdominal sonography for trauma) exam; the procedure involves two steps, and coding for it requires a pair of CPT codes. During a FAST exam, the physician first performs a limited transthoracic echocardiography to check for fluid; then, he performs a limited abdominal study to check for fluid. On your claim, report the following: - 93308 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; follow-up or limited study) for the first part of the FAST exam - 922.1 (Contusion of trunk; chest wall) appended to 93308 to represent the patient's chest bruises - 76705 (Ultrasound, abdominal, real-time with image documentation; limited [e.g., single organ, quadrant, follow-up]) for the second part of the FAST exam - 922.2 (Contusion of trunk; abdominal wall) append-ed to 76705 to represent the patient's abdominal bruises
- modifier 26 (Professional component) appended to 93308 and 76705 to show that you are coding only for the professional portion of the FAST exam. (In the ED setting, the facility will also be able to report the FAST exam with modifier TC [Technical component] appended to 93308 and 76705.)