Ensuring proper coding for liver elastography not only facilitates smooth reimbursements but also helps avoid unnecessary claim denials. At Sonic Incytes, we are committed to providing healthcare providers with the knowledge they need to bill correctly and maximize reimbursement.
This article outlines:
- CPT codes for liver elastography, including a description of CPT code 76981 and CPT code 91200
- Common mistakes in elastography billing
- Best practices for documentation and compliance.
CPT Codes for Liver Elastography
As per the 2024 American College of Radiology (ACR) Ultrasound Coding Guide, there are two primary CPT codes for reporting liver elastography:
- 91200: Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report.
- 76981: Ultrasound elastography; parenchyma (e.g., organ), with imaging.
Key Differences Between 91200 and 76981
Understanding whether a device generates B-mode imaging is crucial for selecting the appropriate code. The distinction between imaging and non-imaging elastography was one of the American Society for Gastrointestinal Endoscopy’s top billing questions for 2024. The ASGE’s recommendation is to reserve the use of 76981 for devices producing a true ultrasound image, which the FDA defines as a B-mode image.
- 91200: Used for devices that perform elastography without B-mode ultrasound imaging.
- 76981: Requires B-mode ultrasound imaging to confirm proper measurement placement and ensure accurate liver assessment.
Note that the FDA classifies A-mode and M-mode as signal visualization modes, as opposed to imaging modes.
Common Mistakes in Elastography Billing
- Incorrectly Reporting Imaging-Based Elastography Under 91200
- Mistake: Billing 91200 when the device uses B-mode imaging.
- Correction: If the device includes B-mode imaging, 76981 should be used instead.
- Using 76981 for Non-Imaging Elastography
- Mistake: Billing 76981 when using a device that does not produce B-mode images.
- Correction: If the system does not generate B-mode images, 91200 is the correct code.
- Failure to Document Imaging Use
- Mistake: Not explicitly documenting the use (or non-use) of B-mode imaging in the patient record.
- Correction: Always include a clear description of the imaging method used during the procedure.
- Omitting Interpretation and Report
- Mistake: Some providers fail to include the interpretation/report required for reimbursement.
- Correction: Ensure that the report includes findings, assessment of liver stiffness, and clinical interpretation for claim approval.
Best Practices for Documentation & Compliance
To minimize denials and optimize billing compliance, follow these best practices:
- Confirm the Imaging Mode by checking the device’s FDA clearance documentation to determine whether it generates B-mode images.
- Ensure Complete Documentation Includes:
- Procedure details (e.g., technique, measurement process).
- Imaging method (B-mode vs. non-imaging elastography).
- Clinical interpretation of results.
- Medical necessity rationale for the elastography assessment.
- Follow Medicare/Medicaid Billing Guidance
- Some payers have specific documentation requirements for elastography reimbursement. Always verify the latest CMS and private payer policies.
- Coding should be done by a professional and it is always the provider’s responsibility to determine and submit appropriate codes, charges, modifiers and bills for the services that were rendered. Sonic Incytes Medical Corp. strongly recommends you consult the payer organization for its reimbursement policies.
Additional Guidance refer to the 2024 ACR Ultrasound Coding Guide and the latest Medicare/Medicaid reimbursement policies.
For guidance on how to bill Velacur, please refer to the Velacur Reimbursement Guide.
