Changes in CPT effective 1/1/07:
76776 Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation
From CPT Changes 2007:
Codes 76700 and 76770 have been editorially revised to substitute the term B-scan with real-time to more accurately describe these procedures. In tandem with these revisions, the introductory notes in the Abdomen and Retroperitoneum subsection were also revised to substitute the term B-scan with real-time to more accurately describe these procedures.
Code 76776 was established to report real-time and duplex Doppler ultrasound of a transplanted kidney with image documentation. Code 76778 was deleted because this service did not reflect current clinical practice. Two parenthetical notes were added to instruct users to report code 76775 for ultrasound of a transplanted kidney without duplex Doppler and to exclude reporting code 76776 in conjunction with codes 93975 and 93976 for inflow and outflow duplex scans.
The typical ultrasound of a transplanted kidney study has changed significantly since the with or without Doppler code was created (76778). The study is now most typically performed with real-time imaging and Doppler. An ultrasound of a transplanted kidney without Doppler is an uncommon study today, but when performed can be accurately reported by the existing limited retroperitoneum code (76775). Code 76776 more accurately describes the current imaging service.
This examination evaluates the transplanted kidney with real-time imaging and Doppler evaluation, including spectral analysis. This complete examination enables the evaluation of not only anatomic abnormalities (eg, hydronephrosis and urinoma), but also includes the evaluation of renal blood flow to detect a variety of vascular complications (eg, renal artery stenosis, thrombosis, renal vein thrombosis, arteriovenous fistuli, and pseudoaneurysms).
B-scan defines the mode in which echo amplitude is characterized by the degree of "B"rightness of the echo. Real-time is the term currently being used for 2D B-mode scans obtained in rapid sequence (ie, greater than 16 frames per second), which give the viewer the sensation of seeing in real time. The term "B-scan" is still valid, but "real-time" more accurately describes how this imaging is being done (except in some ophthalmological applications).
A 60-year-old female presents for routine clinical follow-up 6 months after an uneventful renal transplant. The patient's creatinine and blood pressure are elevated and she is sent for an ultrasound of the transplanted kidney, including real-time, color, and spectral Doppler.
Description of Procedure (76776)
The sonographer performing the exam is supervised. The 2D data for renal anatomy, collecting system dilation, perirenal fluid, and cortical echogenicity is analyzed. The vascular and Doppler information for renal artery stenosis, pseudoaneurysm, venous obstruction, acute tubular necrosis, and rejection is analyzed. The exam is compared and correlated with the findings from previous studies. The report is dictated for the medical record.
/fww comment: Personally, I find the instruction to use 76775 for ultrasound of a transplanted kidney without duplex Doppler somewhat confusing. That is, 76775 is a limited retroperitoneal ultrasound study. However, all the transplanted kidneys I’ve seen have been located in the pelvis, which would seem to make 76856/7 (nonobstetric pelvic ultrasound) more accurate descriptions – but these are just my thoughts and may, as such, be completely wrong … especially when RVUs are considered (although 76857 is approximately equal to 76775) …
Franklin W. West
Pacific Vascular Inc.
(425) 398-7774 (office)
(425) 486-8976 (fax)
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Steve Knight
Sent: Monday, August 13, 2007 9:15 PM
To: [log in to unmask]
Subject: Re: Renal duplex codes
If I was only looking at one kidney (the patient only has one kidney, or a follow up). I would use the charge code for a limited study. Renal transplants have their own charge:
76778 Ultrasound, transplanted kidney, B-scan and/or
real time with image documentation, with or
without duplex Doppler study
On 8/13/07, Denise Levy <[log in to unmask]> wrote:
I don't know of any renal artery study that would be considered limited. A transplant is not that quick with looking at the aorta and iliac artery... renal perfusion has to be evaluated with the entire renal artery. The ICD9 is for HTN or renal insuffiency. 93975 for the complete abd. scan. Denise Levy, Regional Medical Center, San Jose, Ca.
On 8/9/07, Steve Knight <[log in to unmask] > wrote:
On 8/9/07, Willis, Chris <[log in to unmask]> wrote:Steve, do you use the 93975 for a bilateral renal artery duplex?
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