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76536 CPT Code For Thyroid Ultrasound | Description & Billing Guide

The 76536 CPT code for thyroid ultrasound describes the real-time ultrasound imaging of the soft tissue structures in the head and neck. The thyroid gland is a soft tissue in the neck; the ultrasound imaging of the thyroid gland is reported with CPT 76536. 

The thyroid gland does regulate the basal metabolic rate of a human’s body through the secretion of thyroid hormones. It is located in the anterior part of the neck. 

Ultrasonography is an essential investigative tool in medicine. Its high-frequency sound waves generate images of soft tissue structures in the neck and head with procedure 76536 CPT code for thyroid ultrasound.

The sound waves produced by Ultrasonography are transmitted into the body through a transducer. These waves are reflected based on different tissue densities and reflections, which are visualized as images.

An ultrasound imaging of the thyroid gland for the 76536 CPT code thyroid ultrasound procedure is done in the case of an enlarged thyroid gland, abnormal levels of thyroid hormones, or abnormalities in other investigation modalities suggesting an abnormality of the thyroid gland. 

It is worth noting that CPT 76536 is used for ultrasound imaging of the head and neck structures other than the thyroid gland, such as the:

  • parotid gland;
  • sublingual gland;
  • submandibular gland;
  • parathyroid gland; or
  • any other structures in the head and neck. 

Description Of The 76536 CPT Code For Thyroid Ultrasound

As already described, the real-time ultrasound imaging of the thyroid gland is reported with CPT code 76536.

CPT 76536 was proposed in April 2009, and regulators subsequently included its relative value unit in the Medicare Physician Fee Schedule final rule for CY2010.

CPT 76536: The 76536 CPT code is officially described in CPT’s manual as: “Ultrasound, soft tissues of head and neck (for example; thyroid, parathyroid, parotid), real-time with image documentation.”

The diagnostic ultrasound imaging of the thyroid gland coded with CPT 76536 should not be mistaken for other thyroid gland procedures done under an ultrasound’s guidance. 

Thyroid gland biopsy or fine needle aspiration of the thyroid gland can be done under the guidance of ultrasound imaging. 

For example, after an ultrasound imaging of the thyroid gland with a 76536 CPT code procedure, the physician can take a core biopsy of the tissue thyroid gland to test for malignancy, usually done under an ultrasound’s guidance.

This procedure is generally coded with CPT 60100 to describe the core biopsy and CPT 76942 to indicate the ultrasound guidance technique. 

Fine needle aspiration is the preferred form of thyroid biopsy as it is very accurate, less painful, less invasive, and has less risk of bleeding.

Also, fine needle aspiration of the thyroid gland cells can confirm or rule out various thyroid gland diseases such as malignancy.

So it is a standard procedure to be aware of in diagnostic medicine. It can also be done under the guidance of an ultrasound scan and is reported with CPT 10004 and 10005. 

CPT 10005 describes the fine needle aspiration biopsy of the first lesion on soft tissue (in this case, the thyroid gland) under ultrasound guidance. 

CPT 10006 describes the fine needle aspiration biopsy of each additional lesion on soft tissue in addition to CPT 10005. 

A thyroid ultrasound with a Doppler study can also be ordered by the physician alongside the 76942 CPT code procedure as long as the differential diagnosis indicates it. This procedure is usually reported with CPT 93880, which describes the complete spectral analysis of the external carotid artery.

It can also be billed with CPT 93882, which represents a limited or unilateral analysis of the external carotid artery. It is used to assess metastasis of thyroid cancers to regional structures or to access blood flow to thyroid lesions. 

Does Medicare Cover CPT Code 76942?

While some private payers might do so, Medicare CCI edits currently does not support the combination of real-time thyroid gland ultrasound imaging and the ultrasound-guided thyroid gland biopsy or cyst.

Medicare only covers CPT code CPT 76536, if thyroid ultrasound imaging is done on the same encounter as a thyroid gland biopsy under ultrasound guidance, and both CPT 76536 and 60100 are reported and billed separately. 

How To Bill The Thyroid Ultrasound CPT Code 76942

When the ultrasound of another soft tissue structure of the head and neck was performed in the same procedure as the thyroid gland ultrasound, it is appropriate to append this case with modifier 22. 

Whether the thyroid ultrasound procedure was done with a hand-held ultrasound device or a cart-based ultrasound system, the procedure should be coded with CPT 76536 as long as the requirements have been met. 

The thyroid ultrasound CPT code 76942 procedure has a professional and technical component that warrants using modifier TC and modifier 26 where appropriate. 

The global charge is billed without a modifier when the physician owns the ultrasound device and delivers the service directly or via a sonographer.

However, in a hospital setting where the ultrasound device is owned by the hospital and the physician provides the professional service, the physician bills for the professional component with modifier 26 while the hospital bills for the technical element with modifier TC. 

There is always a need to keep a permanent record of the ultrasound images of the 76536 CPT code procedure for thyroid ultrasound in the patient’s history for adequate reimbursement.

The documentation of the ultrasound procedure of soft tissue of the head or neck must be made accessible to the insurer upon inquiry. Each document page must be readable and contain patient identification information, such as the patient’s name, service date, etc. 

The physician or technologist administering the CPT 76536 procedure must have a legible signature on the paperwork. The medical record that has been provided must justify the usage of the chosen ICD-10-CM code (s).

Medical coders must report the 76536 CPT code procedure with the appropriate standard procedural code or healthcare common procedure coding system submitted.

The physician can keep the formal report for ultrasound guidance separately in the patient’s folder or include it in the documentation of the procedure for which the physician used the ultrasound guidance.

Reimbursement

For adequate reimbursement of the 76536 CPT code procedure for thyroid ultrasound must be done with clearly established indications to be considered medically necessary and reasonable by payers.

However, if done as a screening test without any clinical signs or symptoms, it should be indicated in the documentation, and the physician should record the results.

Below are the reimbursement rates for CPT 76536.


Global paymentProfessional component feeTechnical component fee
CPT 76536$118.01$28.87$89.14
Reimbursement for the CPT code for Thyroid Ultrasound

How To Bill Modifier 26, Modifier 22 Modifier TC With CPT Code 76536

Modifier TC and Modifier 26 are necessary to account for the technical and professional components of the 76536 CPT code ultrasound procedure.

The use of these two modifiers is not indicated when billing for the global payment. In that case, the device and procedure are provided by the same person, either physician or the organization. 

One must be careful with modifier 22 when billing the 76536 CPT code procedure. This modifier indicates an increase in the procedural service in which the provided service is substantially more than customarily offered.

But because CPT hasn’t provided a clear explanation of what “significantly more” means, many coders have come up with their interpretation definition. 

In the case of thyroid ultrasound (billed with CPT 76536), modifier 22 indicates the physician did the ultrasound imaging of the thyroid gland along with imaging of other soft tissue structures of the head and neck, i.e., another structure in the head and neck is examined along with the thyroid gland during an ultrasound imaging procedure. 

For example: a physician did lymph node mapping during the thyroid gland ultrasound imaging. Therefore, modifier 22 is appropriate to be billed with CPT code 76536 here as it indicates an extra procedure done during the thyroid gland ultrasound. 

Example

A 56-year-old man presents to the private physician’s office with a history of anterior neck swelling, hyper-defecation, and palpitation. The physician diagnoses a toxic nodular goiter and orders a thyroid gland ultrasound. The physician does not have the equipment for a thyroid ultrasound.

The patient is sent to a diagnostic center for the ultrasound procedure (CPT code 76536), and the report of the ultrasound procedure is brought back and interpreted by the same physician.

This thyroid ultrasound CPT code procedure is billed by the physician and the diagnostic center with the following CPT codes and modifiers:

  • CPT 76536 & Modifier 26
  • CPT 76536 & Modifier TC

Example 2

A 26-year-old woman presented to the hospital with anterior neck swelling, exophthalmos, and tachycardia. An ultrasound scan of the neck was performed, which showed hypo-echogenicity and increased blood flow to the thyroid gland. 

This thyroid ultrasound procedure is reported and billed as CPT 76536.

Example 3

A 45-year-old man presents to the emergency room with anterior neck swelling, tachycardia, and palpitations. The physician orders an ultrasound imaging of the thyroid gland.

This procedure is reported and billed as CPT 76536.

Example 3 

A 55-year-old woman presented to the facility with a five years history of multinodular goiter. First, an anterior neck ultrasound imaging was done, after which an ultrasound-guided fine needle aspiration for cytology was done to rule out a malignancy. 

Both CPT 76536 and CPT 10005 are reported and billed accordingly. 

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