How To Use CPT Code 76604

CPT 76604 refers to an ultrasound of the chest, including the mediastinum, performed in real-time with image documentation. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 76604.

1. What is CPT 76604?

CPT 76604 is a medical procedure code used to describe an ultrasound examination of the chest, including the mediastinum, performed in real-time with image documentation. This diagnostic imaging technique is used to evaluate the pleural spaces for the presence of fluid or masses in the chest, upper back, chest wall, or mediastinum.

2. 76604 CPT code description

The official description of CPT code 76604 is: “Ultrasound, chest (includes mediastinum), real time with image documentation.”

3. Procedure

The 76604 procedure involves the following steps:

  1. The patient is positioned appropriately for the disease process or condition being investigated, such as sitting with arms extended for examination of a pleural effusion.
  2. Acoustic gel is applied to the patient’s skin in the area to be scanned.
  3. The provider places and orients the probe in the best position to scan, for example, between the ribs, as ribs block transmission of ultrasound.
  4. The provider methodically moves the transducer longitudinally from one interspace to another to examine multiple interspaces for a comprehensive analysis of the target effusion or other condition.
  5. After completion of a general examination of the thorax, the provider may concentrate on an area of particular interest to correctly identify structures and conditions.
  6. A chest ultrasound may include transverse, longitudinal, and oblique images of the chest wall with measurements of chest wall thickness.
  7. The provider reviews the images on the monitor and writes and places a report and images into the patient’s chart and sends the same to the requesting physician.

4. Qualifying circumstances

Patients eligible to receive CPT code 76604 services are those who require a diagnostic evaluation of the chest, upper back, chest wall, or mediastinum due to suspected fluid or masses in the pleural spaces. This may include patients with symptoms such as chest pain, shortness of breath, or unexplained weight loss. Additionally, patients with a history of lung disease, chest trauma, or malignancy may also be eligible for this service.

5. When to use CPT code 76604

It is appropriate to bill the 76604 CPT code when a provider performs a chest ultrasound, including the mediastinum, in real-time with image documentation for diagnostic purposes. This may be used to evaluate the pleural spaces for the presence of fluid or masses, assess chest wall thickness, or identify other abnormalities within the chest cavity.

6. Documentation requirements

To support a claim for CPT 76604, the following information should be documented:

  • Indication for the ultrasound examination, such as symptoms or medical history.
  • Details of the patient’s positioning during the procedure.
  • Technique used, including the type of transducer and the application of acoustic gel.
  • Findings from the examination, including any identified abnormalities or measurements of chest wall thickness.
  • A written report and images placed into the patient’s chart and sent to the requesting physician.

7. Billing guidelines

When billing for CPT code 76604, keep in mind the following guidelines:

  • If reporting only the physician’s interpretation for the radiology service, append professional component modifier 26 to the radiology code.
  • If reporting only the technical component for the radiology service, append modifier TC to the radiology code. Note that payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical.
  • Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 76604 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone the following changes:

  • Code Changed on 01-01-2002: Echography, chest, B-scan (includes mediastinum) and/or real time with image documentation.
  • Code Changed on 01-01-2007: Ultrasound, chest, B-scan (includes mediastinum) and/or real time with image documentation.

9. Similar codes to CPT 76604

Five similar codes to CPT 76604 and how they differentiate are:

  1. CPT 76641: This code is for an ultrasound of the breast, which focuses on the breast tissue rather than the chest cavity.
  2. CPT 76700: This code is for an ultrasound of the abdomen, which evaluates the abdominal organs and structures rather than the chest cavity.
  3. CPT 76705: This code is for a limited abdominal ultrasound, which focuses on a specific area of the abdomen rather than the entire chest cavity.
  4. CPT 76856: This code is for an ultrasound of the pelvis, which evaluates the pelvic organs and structures rather than the chest cavity.
  5. CPT 76830: This code is for a transvaginal ultrasound, which is an internal examination of the female reproductive organs rather than an external examination of the chest cavity.

10. Examples

Here are 10 detailed examples of CPT code 76604 procedures:

  1. A patient with a history of lung cancer undergoes a CPT 76604 ultrasound to evaluate for possible recurrence or metastasis.
  2. A patient presenting with chest pain and shortness of breath undergoes a CPT 76604 ultrasound to assess for pleural effusion.
  3. A patient with a history of chest trauma undergoes a CPT 76604 ultrasound to evaluate for any damage to the chest wall or internal structures.
  4. A patient with unexplained weight loss and persistent cough undergoes a CPT 76604 ultrasound to assess for possible malignancy.
  5. A patient with a known pleural effusion undergoes a CPT 76604 ultrasound to monitor the size and location of the effusion.
  6. A patient with a suspected chest wall mass undergoes a CPT 76604 ultrasound to evaluate the mass and surrounding structures.
  7. A patient with a history of asbestos exposure undergoes a CPT 76604 ultrasound to assess for any signs of mesothelioma or other asbestos-related diseases.
  8. A patient with a suspected mediastinal mass undergoes a CPT 76604 ultrasound to evaluate the mass and its relationship to surrounding structures.
  9. A patient with a history of chronic obstructive pulmonary disease (COPD) undergoes a CPT 76604 ultrasound to assess for any changes in lung parenchyma or pleural spaces.
  10. A patient with a suspected diaphragmatic hernia undergoes a CPT 76604 ultrasound to evaluate the diaphragm and surrounding structures.

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