Radiology Coding Alert

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answer.
Question: I am confused about the difference between a regular ultrasound and a color Doppler. I am also unclear about when to code duplex scans and what gets bundled into what. The following report is causing me confusion: What should I do?

"Uterus is normal in size and shape for the patient's age measuring 59 x 30 x 42 mm. The left ovary is relatively large compared to the right and it measures 44 x 45 x 38, and the right measures 25 x 24 mm. Color Doppler imaging shows slightly less Doppler signal on the left than on the right ovary, although arterial pulsations are present. There is a trace of free fluid seen in the cul-de-sac. The right lower quadrant was examined showing no identifiable appendiceal pathology.

"Conclusion: There is a trace of free fluid in the cul-de-sac. The left ovary is enlarged with arterial Doppler signal maintained therein. No appendiceal pathology is detected. The patient's pain is right-sided, and therefore the prominence of the left ovary is not clear as it relates to the patient's clinical findings. Free fluid could represent sequelae of abdominal inflammatory disease including appendicitis, which could not necessarily categorically be ruled out, though there is no evidence sonographically." Minnesota Subscriber                                 Answer: Determining the correct CPT Code for an ultrasonic procedure requires knowledge of the different types of US procedures and their components.

Diagnostic ultrasound is an imaging technique that uses high-frequency ultrasound waves to create images of body structures. These images are usually viewed in black and white, or shades of gray. Many of the ultrasound CPT Code descriptions refer to what is called a B-scan and/or real time. A B-scan is a two-dimensional ultrasonic scanning procedure with a two-dimensional display, while real time indicates two-dimensional scanning with a display of both two-dimensional images and motion with time.

Doppler ultrasonography is defined as the application of diagnostic ultrasound to detect moving blood cells or other moving structures and measure their direction and speed of movement. The Doppler effect is used to evaluate movement by measuring changes in frequency and of the echoes reflected from the moving structures.

Doppler US permits real-time viewing of blood flow that cannot be obtained by other sonographic methods. Doppler provides the ability to observe changes in blood flow, which are displayed in color and can be heard as a change [...]