Oncology & Hematology Coding Alert

Question: Which CPT® code is used to report the ultrasound examination of a palpable mass in the groin? There is a discussion going on in a medical coding forum about it, with some saying it should be 76870 quoting CPT® Assistant and others saying 76882 is correct quoting a professional society. Who is right?

New Jersey Subscriber

Answer: The code choice will depend on documentation of the soft tissue mass location.

By medical definition, the groin is the fold or depression marking the juncture of the lower abdomen and the inner part of the thigh, or the region of that line. There is room for reasonable people to disagree what is meant by groin.

A soft tissue mass in the groin could actually be located in the lower abdomen, the upper thigh, or the scrotum. CPT® offers ultrasound codes dealing with each of those locations.

• Lower abdomen: 76705, Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up)
• Scrotum: 76870, Ultrasound, scrotum and contents
• Thigh: 76882, Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific.

CPT® Assistant (May 2009) lists 76870 as the code for ultrasound of a groin soft tissue mass, but you should choose the code that most accurately matches the chart documentation as to the location. If it is not clear, seek clarification from the rendering provider.

Reimbursement: The relative value units (RVUS), and thus the Medicare national rate, for the professional component of the three codes differ:

• 76705: 0.84 RVUs, $28.59
• 76870: 0.92 RVUs, $31.31
• 76882: 0.70 RVUs, $23.83.