Wiki 76881 Ultrasound coding question

[sahni.vani@gmail.com]

Hi - I am kind of confused with Guidelines , MUE Value and use of modifiers --As per my scenario - Pt is with Bilateral Shoulder pain and Bilateral Knee Pain . What would be correct code here ?

1- As per Guidelines it says ----Regardless of the number of joints examined in a single extremity, CPT code 76881 or 76882 can only be billed once per extremity. 2- MUE Value - 2

I have following -
76881 RT Shoulder
76881 LT Shoulder
76881 RT Knee
76881 LT Knee

Do you think above coding is correct ? is it under MUE value or extremity ?

Thanks
Vani

 

[Pam Warren]

once per extremity would mean you could bill four joints.....LU, LL, RU, RL extremities. Using the laterality modifiers and the appropriate diagnosis code for pain location should help. The LCD from NGS indicates:

1. Bilateral studies are allowed only if there is pathology of both extremities dictating medical necessity for two distinct examinations. It is not reasonable and necessary to perform the contralateral extremity as a "control." That's probably why the MUE is 2.