Question: What is the appropriate code to report an ultrasound (liver) elastography when it was not preceded by an abdominal ultrasound?
Answer: To report ultrasound elastography (USE), it is necessary to perform at least a limited or targeted diagnostic ultrasound to determine the exact location in order to perform the USE. If an ultrasound was performed with documentation of all elements required for coding of a complete abdominal ultrasound, it is appropriate to report CPT codes 76700, Ultrasound, abdominal, real time with image documentation, complete and 0346T, Ultrasound, elastography. If fewer than all of the elements required for coding of a complete ultrasound are imaged and documented, it is appropriate to report codes 76705, Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) and 0346T.
However, if you do not document that you performed a diagnostic ultrasound in conjunction with USE, it is appropriate to report code 76999 Unlisted ultrasound procedure (eg, diagnostic, interventional). It is not appropriate to report 0346T with 76999 as there is a defined list of codes that may be reported with 0346T in the CPT manual.
Finally, if liver elastography is performed without imaging, it is appropriate to report code 91200, Liver elastography, mechanically-induced shear wave (eg, vibration), without imaging, with interpretation and report.
For 2019, Category III code 0346T will be replaced with three new ultrasound elastography Category I codes. There will be stand-alone codes that allow USE to be reported without reporting an additional ultrasound code. Therefore, the above advice will change for 2019.