Find Out the US Imaging Mode for SWE Reporting
Question: I have a gastroenterologist who performed an endoscopic ultrasound (EUS) guided shear wave elastrography (SWE). The provider performed the procedure on both liver lobes and the spleen. Here is the documentation: Endohepatology Procedure: EUS-guided SWE was performed. A total of 10 passes (> 50 percent VSN) were obtained: Left hepatic lobe: mean kPa of 10.5. Right hepatic lobe: mean kPa of 18.9. Spleen: 20.2 kPa. What procedure codes should I use? Utah Subscriber Answer: The CPT® code book includes 91200 (Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report) and 76981 (Ultrasound, elastography; parenchyma (eg, organ)) for reporting liver elastography. The code choice depends on the provider’s use of B-mode US imaging. You’ll assign 91200 when the gastroenterologist performs the EUS-guided SWE without B-mode US imaging, but you’ll use 76981 when B-mode US imaging is used to measure and evaluate the liver. The U.S. Food and Drug Administration (FDA) defines a true ultrasound image as a B-mode image, according to US marketing guidance. In short, double-check the physician’s documentation to confirm the type of EUS imaging used. Use 91200 for imaging without B-mode and assign 76981 for B-mode imaging. Mike Shaughnessy, BA, CPC, Development Editor, AAPC 
