How To Use CPT Code 76642

CPT 76642 is a code for a limited, unilateral breast ultrasound, including axilla when performed. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 76642 procedures.

1. What is CPT 76642?

CPT 76642 is a medical billing code used to describe a limited, unilateral breast ultrasound, which includes the axilla when performed. This code is used when a provider performs a focused ultrasound on a limited area of one breast, and it may involve the axilla along with the breast. The procedure includes documentation of the images obtained during the ultrasound.

2. 76642 CPT code description

The official description of CPT code 76642 is: “Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited.”

3. Procedure

The 76642 procedure involves the following steps:

  1. The patient is appropriately prepped for the ultrasound.
  2. The provider places a transducer probe on the affected part of the breast.
  3. The probe generates sound waves that travel through tissues of different density.
  4. As the sound waves strike various tissues in the breast, the reflected sound waves are displayed as images on a monitor.
  5. The provider documents the images obtained during the ultrasound.
  6. If necessary, the provider may also perform an ultrasound of the axilla along with the breast.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 76642 services include those who require a focused ultrasound on a limited area of one breast. This may be due to a suspicious finding on a mammogram, a palpable lump, or other clinical indications that warrant further investigation. The procedure may also be performed on patients with a history of breast cancer or those who are at high risk for developing breast cancer.

5. When to use CPT code 76642

It is appropriate to bill the 76642 CPT code when a provider performs a limited, unilateral breast ultrasound, including the axilla when performed. This code should be used if the provider does not perform one or more of the elements required for a complete breast ultrasound. If a complete ultrasound of one breast is performed, CPT code 76641 should be used instead.

6. Documentation requirements

To support a claim for CPT 76642, the following information should be documented:

  • Indication for the ultrasound, such as a suspicious finding on a mammogram or a palpable lump.
  • Details of the ultrasound procedure, including the area of the breast examined and whether the axilla was included.
  • Findings and impressions from the ultrasound images, including any abnormalities or concerns.
  • Recommendations for further evaluation or management, if applicable.

7. Billing guidelines

When billing for CPT code 76642, keep in mind the following guidelines and tips:

  • Report CPT 76642 only once per breast, per session.
  • If the provider performs a complete ultrasound of one breast, use CPT 76641 instead.
  • For axillary ultrasound only, use CPT 76882.
  • Append professional component modifier 26 to the radiology code if reporting only the physician’s interpretation for the radiology service.
  • Append modifier TC to the radiology code if reporting only the technical component for the radiology service. 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 76642 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Similar codes to CPT 76642

Five similar codes to CPT 76642 and how they differentiate from CPT 76642 are:

  • CPT 76641: This code is used for a complete ultrasound of one breast, including the axilla when performed.
  • CPT 76882: This code is used for an ultrasound of the extremity, limited, and can be used for axillary ultrasound only.
  • CPT 76880: This code is used for an ultrasound of the extremity, complete.
  • CPT 76700: This code is used for an ultrasound of the abdomen, complete.
  • CPT 76705: This code is used for an ultrasound of the abdomen, limited.

10. Examples

Here are 10 detailed examples of CPT code 76642 procedures:

  1. A patient with a palpable lump in the upper outer quadrant of the left breast undergoes a limited ultrasound of the left breast, including the axilla.
  2. A patient with a suspicious finding on a mammogram in the lower inner quadrant of the right breast undergoes a limited ultrasound of the right breast.
  3. A patient with a history of breast cancer has a limited ultrasound of the left breast to evaluate a new area of concern.
  4. A patient with dense breast tissue undergoes a limited ultrasound of the right breast to further evaluate an area of concern identified on a mammogram.
  5. A patient with a family history of breast cancer has a limited ultrasound of the left breast to evaluate a palpable lump.
  6. A patient with a history of breast implants undergoes a limited ultrasound of the right breast to evaluate a possible implant rupture.
  7. A patient with a history of breast reduction surgery has a limited ultrasound of the left breast to evaluate a new area of concern.
  8. A patient with a history of radiation therapy to the right breast undergoes a limited ultrasound of the right breast to evaluate a new area of concern.
  9. A patient with a history of a benign breast biopsy has a limited ultrasound of the left breast to evaluate a new palpable lump.
  10. A patient with a history of atypical ductal hyperplasia undergoes a limited ultrasound of the right breast to evaluate a new area of concern identified on a mammogram.

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