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Radiology Coding Alert

Reader Question:

76536 Applies to Forehead Ultrasound

Published on Mon Jul 04, 2011

Question: Which code should be used for an ultrasound of the forehead for lesion s/p surgery? Codify Member Answer: The appropriate code is 76536 (Ultrasound, soft tissues of head and neck [e.g., thyroid, parathyroid, parotid], real time with image documentation) for this forehead ultrasound, status post (s/p) surgery. Bonus tip: Remember to append modifier 26 (Professional component) if you're coding only the professional service. This rule holds true even if the radiologist performs the ultrasound herself, in addition to providing the interpretation and report. CPT® Assistant (May 2009) explains that for services performed in a facility setting, "even if the professional acts as the sonographer, use of the code without a modifier is not appropriate as the facility has provided the room and most likely the equipment."
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