ultrasound soft tissue back, ? code

[Susan Carter CPC]

Hello,
We are having difficulty coding ultrasound soft tissue of back. We use 76499 the unlisted procedure and are getting denied by insurances and Medicare asking for a more specific code. We cannot use 76800 ultrasound of spinal canal and contents because we are only scanning the soft tissue of back. Medicare's rejection "MA130" doesn't allow to do a written appeal with the documentation. They want a more specific code. Does anyone have a solution to this problem. I appreciate any help. Thanks.

Susan Carter CPC
Associates in Radiology of Plattsburgh NY PC
aropplattsburgh@hotmail.com

 

[Radcoder1313]

According to CSI, there are two possible codes for soft tissue of the back. 76604-52 is used for the upper back and 76705 for the lower back.

Hope this helps!

 

[Radcoder1313]

According to CSI, there are two possible codes for soft tissue of the back. 76604-52 is used for the upper back and 76705 for the lower back.

Hope this helps!

 

[Susan Carter CPC]

Do you know if CSI has anything published on this issue, or where I can find the guidelines stating that we should use 76604-52 or 76705?

 

[Radcoder1313]

I verified the info in the 2009 CSI Navigator for Diagnostic Radiology.

 

[Verve and bourb]

Per ACR Ultrasound Coding User's Guide Upper Back 76604-52, lower back 76705.

Hope this helps. I would follow ACR guidelines since the AMA tends to rely on the ACR for guidance regarding coding.