CPT Code Announcement

From what I have turned up in my research, they are going to make the 76880 CPT code more granular and specific starting January 1st, 2011. For the broad majority of your exams, you will simply start using 76882 instead.

Here’s the first announcement I found:

As of January 1st, CPT 76880 (ultrasound, extremity, nonvascular, real-time with image documentation) is no more. On January 1st, 2011, nonvascular extremity ultrasound will have two new codes:

CPT 76881 – Ultrasound, extremity, nonvascular, real-time with image documentation, complete.

CPT Guidelines: A complete ultrasound examination of an extremity consists of real-time scans of a specific joint that includes examination of the muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality.

CPT 76882 – Ultrasound, extremity, nonvascular, real-time with image documentation, limited, anatomic specific.

CPT Guidelines: A limited, anatomic-specific ultrasound examination is performed primarily for evaluation of muscles, tendons, joints, and/or soft tissues. It is a limited examination where a specific anatomic structure such as a tendon or muscle [or plantar fascia] is being assessed. The code would also be used to evaluate a soft-tissue mass that may be present in an extremity where knowledge of its cystic or solid characteristic is needed.

UPDATE:

I have been working to get to the bottom of the new CPT codes for podiatry ultrasound. This expansion of the above entry should help clear some things up.

As I said above, 76880 is no more. It’s now broken up into either 76881 (a “complete” exam, mainly of a joint) or 76882 (a “limited” exam, for instance of the plantar fascia).

Originally all reports were pointing toward the reimbursement for 76882 being about the same as the original 76880. But as the pay schedules are being released, we are finding that they have definitely chopped down what you get paid on a “limited” exam.

(The pay on a guided injection or aspiration, using CPT 76942, also went down a little bit, but not as much. Those will continue to be strong earners for your practice.)

What we need to work out now — and I am going to be investigating this for you — is where you can best make use of the higher-paying 76881.

I’m thinking this will be primarily for ankle examinations and for joints in the mid-foot (e.g., the subtalar joint and the midtarsal joints, or the conditions that affect the great toe joint), but I want to work out the best protocols and most rock-solid ways of documenting these exams, so you can perform them (and bill for them) with confidence.

Here is a more detailed (and well-written) explanation of the new CPT payment schedules for 76881 and 76882, as given by Phil Ward, DPM, from South Carolina, which one of my clients forwarded to me. I’m enclosing it between sets of asterisks …

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Bottom line is that CMS thought the old lower extremity ultrasound code was overvalued, so they asked CPT for a new code. Radiology and podiatry presented the rationale at CPT for the new codes to replace 76880.

Those codes would include the following:

76881 is for a complete exam which includes a joint and all the soft tissue around the joint.

76882 is for an isolated soft tissue such as plantar fascia or an Achilles tendon (much less work).

If medically necessary both of these codes can be billed bilaterally or you could do one 76881 on one limb and one 76882 on the other, again if medically necessary.

The RUC valued the new codes at:
76881 – 3.30
76882 – 0.89

The value of the old 76880 was 3.47. So if you are doing a full complete exam in 2011 (which is what you were being paid for in 2010 but probably were not actually doing) you will be paid relatively the same value (3.47 compared to 3.30). If you are only doing the limited, however, you are getting paid for less work because it actually is less work than the complete.

Thanks to the work of APMA most of the revalued RVUs that podiatry uses went up in 2011, but to stay budget neutral CMS lowered the conversion factor for all codes. All specialties are getting screwed, but we as a specialty will do better in 2011 than most others.

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So, long story short, it appears they have decided that quick exams of the foot or ankle won’t pay as much as they once did.

If it helps at all to think of it this way, even at $25 for a 3-min plantar fascia exam, it works out to an equivalent $500/hour. And it’s still helpful in other ways of course.

(One other potential benefit in all this would seem to be that, if they are paying less for the exams, they won’t flinch if you start performing a lot more of them. It seems very doubtful — more doubtful than before — that they would ever just do away with it at this point. They’ve re-valued it, yes, but it’s still here, and should be here to stay.)

Guided injections are of course still profitable, and I hope to build up some additional training materials here soon on injections and aspirations. You can earn good money there still.

And again, I’m going to be working with some of my most experienced clients to put together some solid ankle protocols that will enable you to confidently charge the 76881 code for the higher reimbursement figure.

Stay tuned. I can’t control CPT codes, but I will do what I can to make this transition easier, and you can be sure I will be looking to put the protocols in place so you can bill more of the higher-paying 76881 and 76942 codes.