Coding for arthritis ultrasound survey when multiple joints are requested for one session, whether ipsilateral or bilateral, and for complete imaging of a single joint

Q.

I am confused about a another answer regarding an ultrasound arthritis survey. You stated that when multiple joints are imaged ipsilaterally by ultrasound, then you should report an unlisted code. However, if the physician completes imaging described by CPT^® code 76881 bilaterally questioning arthritis, that would be defined by CPT coding such as 76881-50 or RT, LT, because it is not ipsilateral. Is that your understanding as well?  Is there additional information that you would have on the issue that you could direct me to?

A.

The unlisted code for an US arthritis survey is used when multiple joints are requested at the same session, whether ipsilateral or bilateral, such as bilateral hands, bilateral feet, bilateral wrists, and bilateral ankles, all requested at the same time for arthritis, or it could be unilateral hip, knee, ankle, foot. This would be analogous to a bone survey but done with ultrasound instead of x-ray.

The code and full description are:

76881 Ultrasound, complete joint (i.e., joint space and peri-articular soft tissue structures) real-time with image documentation

It is generally not going to be used when just the ankles or just the hips are ordered, even if the diagnosis is arthritis. Your diagnosis will often be rule/out arthritis. CPT code 76881 is reported for complete imaging of a single joint.

The Winter 2015 issue of Clinical Examples in Radiology included a sample case with an ultrasound of multiple joints for arthritis. Part of the discussion included the following:

“In addition, the report describes an ultrasound extremity survey to evaluate for arthritis in multiple joints. The use of code 76881, Ultrasound, extremity, nonvascular, real-time with image documentation; complete, and code 76882, Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific, multiplied by the number of joints evaluated is inappropriate. Therefore, unless a new code or series of codes for an ultrasound extremity survey study is created, this type of extremity survey should be reported with code 76999, Unlisted ultrasound procedure (eg, diagnostic, interventional).”