CPT Code 76641 and 76642: Best Breast Ultrasound Coding Guide (2023)

FAQs

What is the difference between 76641 and 76642? ›

Code 76641 describes a complete examination of all four quadrants of the breast and the retroareolar region; 76642 describes a limited breast ultrasound (e.g., a focused examination limited to one or more elements of 76641, but not all four).

There is only one CPT code for all breast ultrasounds: 76645.

76642 (ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited)

Per the CPT® 2021 codebook, Professional Edition, p. 536, code 76641 represents a complete ultrasound examination of the breast.

There should not be two CPT codes billed if a bilateral ultrasound exam is needed.

If performed bilaterally, a modifier 50 may be reported with CPT code 76641 or 76642.

Ultrasound CPT Code Updates - 2022

The CPT (Current Procedural Terminology) code range for Diagnostic Ultrasound Procedures 76506 - 76999 is a medical code set that is maintained by the AMA (American Medical Association).

Diagnostic Ultrasound Procedures CPT^® Code range 76506- 76999. The Current Procedural Terminology (CPT) code range for Diagnostic Ultrasound Procedures 76506-76999 is a medical code set maintained by the American Medical Association.

The Current Procedural Terminology (CPT^®) code 76642 as maintained by American Medical Association, is a medical procedural code under the range - Diagnostic Ultrasound Procedures of the Chest.

What is the difference between complete breast ultrasound and limited? ›

According to the American College of Radiology, a complete examination must include all four quadrants of the breast and the retroareolar region. It also includes ultrasound examination of the axilla, if performed. A study that does not meet these criteria is considered to be limited.

CPT® Code 76641 - Diagnostic Ultrasound Procedures of the Chest - Codify by AAPC.

ICD-10 code Z12. 39 for Encounter for other screening for malignant neoplasm of breast is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

CPT Code 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection and localization device), imaging supervision and interpretation, is an appropriate code for certain procedures when performed. In these cases, the primary injection code is billed in addition to 76942 for ultrasound guidance.

CPT 76642: Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited. Report 76641, 76642 only once per breast, per session. Listed under Diagnostic Ultrasound Category. CPT page 468.

It means that the doctors have found something they want to look at more closely. If you get called back, it's usually to take new pictures or get other tests. Fewer than 1 in 10 women called back for more tests are found to have cancer.

Diagnostic mammography, diagnostic tomosynthesis, breast ultrasound and breast MRI are not considered preventative care and are therefore subject to your individual policy benefits to include deductibles, co-insurance and/or co-pays.

Modifier 25 would be applicable to the E/M in this scenario, as the ultrasound procedure was used in an attempt to diagnose an abnormality and is not a procedure that should be considered included a routine OBGYN office visit; 99213-25; 76830.

ICD-10 code R92. 8 for Other abnormal and inconclusive findings on diagnostic imaging of breast is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .

When to use 52 or 53 modifier? ›

Depending on the circumstances as to why the procedure was stopped, modifier 52 is reportable if no anesthesia was administered and the physician elected to terminate the procedure. However, modifier 53 would be applicable if anesthesia was administered and the procedure was terminated due to extenuating circumstances.

Today, mammography is the gold standard in breast cancer screening in the general population, and, looking ahead, researchers continue to explore ways to improve mammography and screening technologies.

Cancerous masses and calcium deposits appear brighter on the mammogram. This method is good for detecting Ductal Carcinoma In Situ (DCIS) and calcifications. Currently, mammography is the gold standard method to detect early stage breast cancer before the lesions become clinically palpable.

(CPT codes 92585 and 92586 were deleted on January 1, 2021. CPT code 92564 was deleted on January 1, 2022.) 2. Speech language pathologists may perform services coded as CPT codes 92507, 92508, or 92526.

The Current Procedural Terminology (CPT^®) code 76604 as maintained by American Medical Association, is a medical procedural code under the range - Diagnostic Ultrasound Procedures of the Chest.

In short, the ICD-10 codes and diagnoses justify your POCUS billing. Insurance providers/payers regularly perform payment edits by cross-screening logged CPT procedures against ICD-10 diagnoses to detect claims with a high probability of being incorrect, inappropriate, or not medically necessary.

Abnormal ultrasonic finding on antenatal screening of mother

O28. 3 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM O28. 3 became effective on October 1, 2022.

Hence, the primary code is always the surgery procedure code followed by the guidance code like 76942. Most of the major procedures have now bundled the guidance including the breast biopsy and spinal injection procedures, hence be careful while using the guidance codes.

Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.

What documentation is required for CPT 76942? ›

Secondly, like with 76942, the code “requires a permanent recorded image(s) of the vascular access site to be included in the patient record, as well as a documented description of the process either separately or within the procedure report.”

76942 is used to report the application of ultrasound to guide injections or aspirations, that is, ultrasonic guidance for needle placement, such as biopsy, aspiration, injection, or localization device, as well as imaging supervision and interpretation.

Only report 76942 with modifiers 59 or –X{EPSU} if the ultrasonic guidance for needle placement is unrelated to the laparoscopic liver tumor ablation procedure. Don't report CPT code 76000 with or without modifiers 59 or –X{EPSU} for fluoroscopy in conjunction with a cardiac catheterization procedure.

A breast ultrasound isn't typically a screening tool for breast cancer. Instead, a physician might order an ultrasound, also called a sonogram, of the breasts if a screening mammogram produces unusual results. A physician might also use a breast ultrasound as a visual guide while performing a biopsy of the breasts.

BI-RADS category 4 means there is a suspicious abnormality on your breast imaging studies and a biopsy should be considered as a next step.

Breast ultrasound is an imaging test that uses sound waves to look at the inside of your breasts. It can help your healthcare provider find breast problems. It also lets your healthcare provider see how well blood is flowing to areas in your breasts.

CPT Code 99453

CPT Code 99454 is used for the monthly remote monitoring of physiological parameters, and covers the supply of the devices used by patients to monitor and record physiological data.

CPT® Code 99241 - New or Established Patient Office or Other Outpatient Consultation Services - Codify by AAPC.

Physicians may bill initial hospital care service codes (99221-99223), for services that were reported with CPT^® consultation codes (99241 – 99255) prior to January 1, 2010, when the furnished service and documentation meet the minimum key component work and/or medical necessity requirements.

BI-RADS 3 is an intermediate category in the breast imaging reporting and data system. A finding placed in this category is considered probably benign, with a risk of malignancy of > 0% and ≤ 2%⁴.

What is breast ultrasound Category 5? ›

Category 5

Scoring 5 indicates a high suspicion of cancer. In this instance, there's at least a 95 percent chance of breast cancer. A biopsy is highly recommended to confirm results and determine the next steps for treatment.

The biggest change in the current guideline is that we now recommend that women at average risk for breast cancer start annual screening with mammograms at age 45, instead of age 40 (which was the starting age in our previous guideline). Women ages 40 to 44 can choose to begin getting mammograms yearly if they want to.

CPT® Code 76642 - Diagnostic Ultrasound Procedures of the Chest - Codify by AAPC.

In general, there are two main types of mammograms: Digital mammography in 2D. Digital mammography in 3D (digital breast tomosynthesis).