Medical Coding & Billing for Ultrasound: Guidelines & Tips

Ultrasound, or sonography, is a widely used diagnostic tool in modern healthcare. Accurate coding and billing are essential to ensure proper reimbursement and compliance with payer policies. Whether you’re coding abdominal, obstetric, vascular, or cardiac ultrasounds, understanding CPT, ICD-10, and billing requirements is key.

Know Your Ultrasound CPT Codes

Ultrasound procedures are primarily billed using CPT codes (Current Procedural Terminology). These codes vary depending on the area of the body examined and the purpose of the scan. Ultrasound CPT codes generally fall into two types:

• Complete vs. Limited Exams

  • Complete: Includes all necessary anatomical structures (e.g., CPT 76700 – complete abdominal ultrasound).

  • Limited: Focuses on a specific area or problem (e.g., CPT 76705 – limited abdominal ultrasound).

Common CPT Codes for Ultrasound:

Tip: Always check if a study qualifies as “complete.” If certain views aren’t obtainable or ordered, use the “limited” code.

Link CPT to the Appropriate ICD-10 Code

CPT codes must be supported by medical necessity—this is where ICD-10 codes come in. Use diagnosis codes that justify the ultrasound. Common examples:

• R10.9 – Abdominal pain, unspecified

• N39.0 – Urinary tract infection

• Z34.00 – Supervision of normal first pregnancy, unspecified trimester

Tip: Review payer policies for “acceptable” diagnosis codes for each ultrasound type to avoid denials.

ICD-10 Steps to Code https://codingclarified.com/medical-coding-steps-for-icd-10-cm/

Documentation is Key

Documentation should include:

• The medical necessity for the ultrasound

• The body area or organ system examined

• Whether the study was complete or limited

• Any findings or impressions

Tip: Incomplete documentation can result in downcoding or denial. Make sure the physician’s notes support the CPT code billed.

Know the Modifier Rules

Modifiers help explain special circumstances:

• Modifier -26: Professional component (interpretation only)

• Modifier -TC: Technical component (equipment use only)

• Modifier -59 or XU: Distinct procedural service (used to differentiate separate services)

Example:

• If billing for interpretation only: 76700-26

Tip: Never append modifiers unless supported by documentation and payer rules.

CPT Modifiers https://codingclarified.com/cpt-medical-modifiers/

Billing for Point-of-Care Ultrasound (POCUS)

POCUS performed at the bedside must meet the same documentation requirements. Include:

• Who performed it

• Why it was done

• Findings

• Saved images

Not all payers reimburse for POCUS. Check policies first.

Understand Global Periods and Bundling

Ultrasounds related to surgery may be considered part of the global surgical package and not separately billable. Also, watch for bundled services under Medicare and commercial plans.

Tip: Use NCCI Edits (National Correct Coding Initiative) to determine when services can be billed together.

Medical Coding Bundling and Upcoding https://codingclarified.com/medical-coding-bundling-and-upcoding-guidelines/

Medical Coding and Billing and the Global Period https://codingclarified.com/medical-coding-and-billing-and-the-global-period/

Final Takeaways

Correct coding and billing for ultrasound services require close attention to detail, documentation, and payer-specific rules. By staying current with CPT, ICD-10, and modifier guidelines, you ensure compliance, reduce denials, and optimize reimbursement.

AAPC Codify https://www.aapc.com/codes/cpt-codes-range/76506-76999/