ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the provider performed an ultrasound (US) on the patient’s pectoral area including the mediastinum. I reported 76641 x 2 and received a denial; what did I do wrong?

Answer: Your choice was a bit off based on anatomy. The code you were looking for is 76604 (Ultrasound, chest (includes mediastinum), real time with image documentation). You only need to report the code once because, as the descriptor states, the code includes the chest and the mediastinum.

The code you reported, 76641, is specifically for breast US. If you encounter notes in the future that indicate a unilateral breast US, choose from 76641 (Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete) and 76642 (… limited), as appropriate.