How To Use CPT Code 91200

CPT 91200 is a code used for liver elastography procedures, mechanically induced shear wave, without imaging, with interpretation and report. 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 91200 procedures.

1. What is CPT 91200?

CPT 91200 is a medical billing code used to describe a specific type of liver elastography procedure. This procedure is performed to determine the presence and nature of tumors in the liver, differentiating between malignant and nonmalignant tumors, as well as distinguishing lesions from normal tissue. The code is used for mechanically induced shear wave elastography without imaging, and includes the interpretation and report of the findings.

2. 91200 CPT code description

The official description of CPT code 91200 is: “Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report.”

3. Procedure

The 91200 CPT code procedure involves the following steps:

1. The provider applies gel over the right upper portion of the patient’s abdomen to examine the liver for the presence of tumors.
2. Mechanical vibrations are induced in the liver tissues to observe their elastic properties and displacement.
3. The provider uses various formulas to calculate the degree of displacement of the tissues being examined.
4. The data is interpreted, and a report on the findings is completed.

4. Qualifying circumstances

Patients eligible to receive CPT code 91200 services are those who have a suspected liver tumor or lesion, or those with a known liver tumor or lesion requiring further evaluation. The procedure is typically performed when noninvasive imaging methods, such as ultrasound or MRI, are inconclusive or insufficient for determining the nature of the liver abnormality.

5. When to use CPT code 91200

It is appropriate to bill the 91200 CPT code when a provider performs a liver elastography procedure using mechanically induced shear wave, without imaging, and includes the interpretation and report of the findings. This code should be used when the procedure is medically necessary for the evaluation and management of a patient with a suspected or known liver tumor or lesion.

6. Documentation requirements

To support a claim for CPT 91200, the following information should be documented:

• Patient’s medical history and physical examination findings related to the liver abnormality
• Indication for the liver elastography procedure, including the reason for its necessity
• Description of the procedure performed, including the method of mechanically induced shear wave elastography used
• Interpretation of the elastography findings, including the degree of tissue displacement and any identified tumors or lesions
• Report of the findings, including any recommendations for further evaluation or management

7. Billing guidelines

When billing for CPT code 91200, it is important to follow the appropriate billing guidelines and rules. These may include:

• Ensuring that the procedure is medically necessary and supported by the patient’s medical history and physical examination findings
• Documenting the procedure, interpretation, and report in the patient’s medical record
• Using the appropriate modifiers, if necessary, to indicate any special circumstances related to the procedure
• Not reporting CPT 91200 in conjunction with codes 76981, 76982, or 76983, as these codes represent similar procedures with imaging

8. Historical information

CPT 91200 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 91200

There are several codes similar to CPT 91200, which differentiate in the following ways:

• CPT 76981: This code is used for ultrasound elastography procedures with imaging, focusing on a single organ.
• CPT 76982: This code is used for ultrasound elastography procedures with imaging, focusing on multiple organs or a limited area.
• CPT 76983: This code is used for ultrasound elastography procedures with imaging, focusing on a complete assessment of an organ.
• CPT 76391: This code is used for magnetic resonance elastography procedures with imaging, including the interpretation and report.
• CPT 0346T: This code is used for acoustic radiation force impulse (ARFI) elastography procedures with imaging, including the interpretation and report.

10. Examples

Here are 10 detailed examples of CPT code 91200 procedures:

1. A patient with a history of liver cirrhosis presents with a new liver lesion detected on ultrasound, requiring further evaluation using liver elastography.
2. A patient with a known liver tumor requires a follow-up liver elastography procedure to monitor the tumor’s progression and response to treatment.
3. A patient with a suspected liver tumor based on physical examination findings undergoes a liver elastography procedure for further evaluation.
4. A patient with inconclusive MRI findings of a liver lesion undergoes a liver elastography procedure to determine the nature of the lesion.
5. A patient with a history of liver cancer undergoes a liver elastography procedure as part of their routine surveillance for tumor recurrence.
6. A patient with a suspected liver tumor based on abnormal liver function tests undergoes a liver elastography procedure for further evaluation.
7. A patient with a known liver tumor requires a liver elastography procedure to assess the tumor’s elasticity and guide treatment decisions.
8. A patient with a suspected liver tumor based on imaging findings undergoes a liver elastography procedure to confirm the presence of the tumor and determine its nature.
9. A patient with a history of liver disease presents with new symptoms suggestive of a liver tumor, requiring further evaluation using liver elastography.
10. A patient with a known liver tumor requires a liver elastography procedure to assess the tumor’s response to a new treatment regimen.