CPT 76870 is an ultrasound procedure code for the scrotum and its contents, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.
1. What is CPT 76870?
CPT 76870 is a medical billing code used to describe an ultrasound examination of the scrotum and its contents, which include the testicles, epididymis, and spermatic cord. This diagnostic imaging procedure is performed to assess and diagnose various disorders related to the male reproductive system, such as testicular torsion, epididymitis, hydrocele, and other abnormalities.
2. 76870 CPT code description
The official description of CPT code 76870 is: “Ultrasound, scrotum and contents.”
- The patient is positioned comfortably on an examination table, usually lying on their back with their legs slightly apart.
- The physician or ultrasound technician applies a conductive gel to the skin overlying the scrotum. This gel helps transmit the high-frequency sound waves from the ultrasound probe to the underlying tissues.
- A transducer, or ultrasound probe, is pressed against the skin and moved over the scrotal area. The transducer emits high-frequency sound waves that penetrate the tissues and create echoes as they bounce off internal structures.
- The ultrasound machine processes the echoes and generates real-time images of the scrotum and its contents, which are displayed on a monitor for the physician or technician to analyze.
- The physician or technician may take measurements and document any abnormalities or findings during the examination.
- After the examination is complete, the conductive gel is wiped off, and the patient can get dressed and leave the examination room.
4. Qualifying circumstances
Patients who are eligible to receive CPT code 76870 services include those presenting with symptoms or clinical findings suggestive of scrotal or testicular disorders, such as pain, swelling, masses, or trauma. Additionally, patients with a history of infertility, testicular cancer, or other reproductive system abnormalities may also be candidates for this diagnostic imaging procedure.
5. When to use CPT code 76870
It is appropriate to bill the 76870 CPT code when a physician or ultrasound technician performs a diagnostic ultrasound examination of the scrotum and its contents to evaluate, diagnose, or monitor various scrotal or testicular disorders. This may include cases of acute scrotal pain, testicular masses, hydroceles, varicoceles, epididymitis, testicular torsion, or other abnormalities.
6. Documentation requirements
To support a claim for CPT 76870, the following information should be documented in the patient’s medical record:
- Indication for the ultrasound examination, such as the patient’s symptoms, clinical findings, or relevant medical history.
- A detailed description of the ultrasound technique used, including the type of transducer and any adjustments made during the examination.
- A comprehensive report of the ultrasound findings, including the size, shape, and echogenicity of the testicles, epididymis, and spermatic cord, as well as any abnormalities or masses detected.
- Measurements and calculations, if applicable, such as testicular volume or blood flow assessments.
- Interpretation of the ultrasound findings and their clinical significance, including any diagnoses or recommendations for further evaluation or treatment.
7. Billing guidelines
When billing for CPT code 76870, it is essential to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some key points to consider include:
- Appending modifier 26 to the radiology code when reporting only the physician’s interpretation of the radiology service.
- Appending modifier TC to the radiology code when reporting only the technical component of the radiology service. Note that some payer policies may exempt hospitals from appending modifier TC, as their portion is inherently technical.
- Not appending 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 76870 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2002, from its previous descriptor, “Echography, scrotum and contents.”
9. Similar codes to CPT 76870
Five similar codes to CPT 76870 and how they differentiate from it are:
- CPT 76856: This code is for an ultrasound examination of the pelvis, which includes the uterus, ovaries, and adnexa, making it more applicable to female patients.
- CPT 76857: This code is for a limited or follow-up ultrasound examination of the pelvis, focusing on a specific area or issue rather than a comprehensive evaluation.
- CPT 76700: This code is for an ultrasound examination of the abdomen, which includes the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, and abdominal aorta.
- CPT 76705: This code is for a limited or follow-up ultrasound examination of the abdomen, focusing on a specific area or issue rather than a comprehensive evaluation.
- CPT 76770: This code is for an ultrasound examination of the retroperitoneum, which includes the kidneys, ureters, and urinary bladder, as well as the surrounding tissues and blood vessels.
Here are 10 detailed examples of CPT code 76870 procedures:
- A 25-year-old male presents with acute scrotal pain and swelling, and the physician orders a scrotal ultrasound to rule out testicular torsion.
- A 35-year-old male with a history of infertility undergoes a scrotal ultrasound to evaluate for the presence of a varicocele.
- A 45-year-old male presents with a palpable testicular mass, and the physician orders a scrotal ultrasound to assess for testicular cancer.
- A 55-year-old male with a history of epididymitis undergoes a scrotal ultrasound to monitor the resolution of the infection and any potential complications.
- A 65-year-old male presents with scrotal swelling and discomfort, and the physician orders a scrotal ultrasound to evaluate for a hydrocele.
- A 30-year-old male with a history of testicular trauma undergoes a scrotal ultrasound to assess for any long-term complications or abnormalities.
- A 40-year-old male presents with chronic scrotal pain, and the physician orders a scrotal ultrasound to evaluate for any underlying disorders or abnormalities.
- A 50-year-old male with a history of testicular cancer undergoes a scrotal ultrasound as part of a routine follow-up to monitor for any recurrence or metastasis.
- A 60-year-old male presents with a sudden onset of scrotal pain and swelling, and the physician orders a scrotal ultrasound to evaluate for a possible spermatic cord torsion.
- A 70-year-old male with a history of prostate cancer undergoes a scrotal ultrasound to assess for any potential metastasis or involvement of the testicles.