Radiology Coding Alert

Question: On a couple of occasions, our radiologists have been asked to perform an ultrasound of the axillary breast area to evaluate the axillary lymph nodes. Some-times it is done with a mammogram, but sometimes not. I can't find a specific code for this. Would 76970 be the best choice?

New Hampshire Subscriber  
Answer: There is no specific code to describe ultrasound of the axillary lymph nodes; it would not be appropriate to assign 76970 (ultrasound study follow-up [specify]) since the procedure is not a follow-up evaluation.
 
Practices should use diagnostic ultrasound code 76999 (unlisted ultrasound procedure) and submit it with a report outlining the study conducted. Alternatively, the breast ultrasound code 76645 (echography, breast[s] [unilateral or bilateral], B-scan and/or real time with image documentation) might be reported. This is appropriate only if portions of the breast are imaged, as well as the axillary area. Code 76645 could be reported with modifier -52 to indicate reduced services.
 
If the ultrasound study is conducted with mammography, the appropriate mammography code should also be submitted (i.e., 76090, mammogaphy; unilateral, or 76091, ... bilateral).