Radiology Coding Alert

Master mediastinum requirement for this chest ultrasound code. The phrase "includes mediastinum" in 76604's descriptor raises a question: Must the service include a mediastinum exam? AMA's CPT Assistant (May 2009) erases the confusion by providing a clear answer: No. Instead, the phrase "includes mediastinum" indicates that if the provider performs and documents an examination of the mediastinum, you should include it in chest US code 76604 (Ultrasound, chest [includes mediastinum], real time with image documentation), says Elijah Berg, MD, FACEP, CEO of MRSI, a coding and billing company in Woburn, Mass. In other words: While the code descriptor does mention a mediastinum exam explicitly, you can report 76604 regardless of whether the physician documents examination of the area. You cannot, however, report a mediastinum exam separately if the physician notes it during a chest US. Mediastinum defined: According to Dorland's Dictionary, the mediastinum is "the mass of tissues and organs [...]