How To Use CPT Code 76872

CPT 76872 is a code for transrectal ultrasound procedures, 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 76872?

CPT 76872 is a medical billing code used for transrectal ultrasound procedures. This diagnostic imaging technique is performed to assess disorders of the prostate, rectum, and surrounding tissues. It is an essential tool for diagnosing and monitoring various conditions, including prostate cancer, benign prostatic hyperplasia, and prostatitis.

2. 76872 CPT code description

The official description of CPT code 76872 is: “Ultrasound, transrectal.”

3. Procedure

1. The patient is prepared for the procedure, which may include sedation and positioning on their side with knees tucked up toward the chest.
2. The provider inspects the anus and perianal area and may perform a digital rectal exam.
3. An ultrasound transducer, sheathed in a plastic covering with gel, is gently inserted into the rectum.
4. Once past the anal sphincter, the provider moves the transducer around to examine the base of the prostate and seminal vesicles.
5. The transition and peripheral zones of the prostate are examined in the axial and sagittal planes.
6. The urethra, verumontanum, and neurovascular structures are identified.
7. Prostate volume is measured by imaging the transverse and anteroposterior dimensions at the estimated point of the widest transverse dimension in the axial plane and the longitudinal dimension in the sagittal plane just off the midline.
8. A formula, such as the ellipsoid volume formula, is applied to the measurements to determine prostate volume.
9. Once the examination is complete, the provider removes the ultrasound transducer from the rectum.

4. Qualifying circumstances

Patients eligible to receive CPT code 76872 services are those who present with symptoms or conditions that warrant a transrectal ultrasound examination. These may include, but are not limited to, urinary symptoms, elevated prostate-specific antigen (PSA) levels, abnormal digital rectal exam findings, or a history of prostate cancer.

5. When to use CPT code 76872

It is appropriate to bill the 76872 CPT code when a provider performs a transrectal ultrasound to assess disorders of the prostate, rectum, and surrounding tissues. This may be done for diagnostic purposes, monitoring of existing conditions, or as part of a treatment plan.

6. Documentation requirements

To support a claim for CPT 76872, the following information should be documented:

• Indication for the procedure, such as symptoms or conditions warranting the examination
• Details of the patient’s medical history and physical examination
• Findings of the transrectal ultrasound, including measurements and any abnormalities identified
• Interpretation and impression of the ultrasound findings
• Any recommendations for further evaluation or treatment

7. Billing guidelines

When billing for CPT code 76872, it is essential to follow the appropriate guidelines and rules. Some tips include:

• Use separate codes for diagnostic ultrasound (76872) and ultrasound guidance (76942) if both are performed during the same session.
• Consider reporting a cyst aspiration code, such as 10160, depending on the nature of the procedure.
• Study modifier options and ascertain payer preferences when reporting multiple procedures.
• 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 76872 was added to the Current Procedural Terminology system on January 1, 1990. There have been updates to the code since its addition:

• Code Changed on 01-01-2010: Ultrasound, transrectal
• Code Changed on 01-01-2004: Echography, transrectal

9. Similar codes to CPT 76872

Five similar codes to CPT 76872 and how they differentiate are:

• CPT 76870: This code is for ultrasound examination of the scrotum and contents, not involving the rectum.
• CPT 76856: This code is for a complete pelvic ultrasound examination, which may include the prostate but is not limited to transrectal imaging.
• CPT 76857: This code is for a limited or follow-up pelvic ultrasound examination, which may include the prostate but is not limited to transrectal imaging.
• CPT 76873: This code is for a transrectal ultrasound prostate volume study specifically for brachytherapy treatment planning.
• CPT 76942: This code is for ultrasound guidance for needle placement, which may be used in conjunction with CPT 76872 for procedures such as cyst aspiration.

10. Examples

Here are 10 detailed examples of CPT code 76872 procedures:

1. A patient with elevated PSA levels undergoes a transrectal ultrasound to assess for prostate cancer.
2. A patient with urinary symptoms suggestive of benign prostatic hyperplasia undergoes a transrectal ultrasound to evaluate prostate size and shape.
3. A patient with a history of prostate cancer undergoes a transrectal ultrasound to monitor for recurrence or progression of the disease.
4. A patient with chronic prostatitis undergoes a transrectal ultrasound to assess the extent of inflammation and guide treatment decisions.
5. A patient with an abnormal digital rectal exam undergoes a transrectal ultrasound to further evaluate the prostate and surrounding tissues.
6. A patient with a known prostatic cyst undergoes a transrectal ultrasound to monitor the size and appearance of the cyst over time.
7. A patient undergoing brachytherapy for prostate cancer undergoes a transrectal ultrasound to assist in treatment planning.
8. A patient with rectal bleeding undergoes a transrectal ultrasound to evaluate the rectum and surrounding tissues for potential causes.
9. A patient with a suspected seminal vesicle disorder undergoes a transrectal ultrasound to assess the anatomy and function of the seminal vesicles.
10. A patient with a history of pelvic radiation therapy undergoes a transrectal ultrasound to monitor for radiation-induced changes in the prostate and surrounding tissues.