Get a DRG grouping summary and IPPS payment calculation with your code search and crosswalks!Learn More

Ask an Expert

Answers to Compliance and Medical Coding Questions.
  1. SuperCoder Posted 7 Year(s) agoRelated Topics

    76881 & 76882 are these to be used for upper & lower exams. And what defines limited vs complete

  2. SuperCoder Posted 7 Year(s) ago

    76882 is used Anatomy specific, whereas 76881 is used for Complete study including multiple extremities, be it lower or upper limbs.

  3. SuperCoder Posted 7 Year(s) ago

    A complete ultrasound examination of an extremity (76881) 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.

    A limited examination of an extremity (76882) that would be performed primarily for evaluation of muscles, tendons, joints, and/or soft tissues. This is a limited examination of the extremity where a specific anatomic structure such as a tendon or muscle is assessed.

    Hope, it would clarify you so well.

  4. Cathy Posted 7 Year(s) ago

    Do you know why the reimbursement of the limited exam is so significantly lower than the complete?

  5. SuperCoder Posted 7 Year(s) ago

    Lower Extremity Ultrasound, CPT codes 76881 and 76882
    CMS disagreed with the RUC recommendations for the two lower extremity ultrasound
    codes, 76881 (Ultrasound, extremity, nonvascular, real-time with image documentation;
    complete) and 76882 (Ultrasound, extremity, nonvascular, real-time with image
    documentation; limited, anatomic specific). CMS indicates that 76881will be used for
    evaluation of the lower extremity in the same manner as 76880 (Ultrasound, extremity,
    nonvascular, real time with image documentation), the code being replaced by these two
    codes. Based on Medicare claims data, podiatry was the dominant provider of 76880 and
    their specialty acknowledged that they more commonly perform a limited ultrasound
    examination, which will now be reported as 76882. In other words, the services that are
    currently reported using code 76880 will actually be reported more commonly with
    76882, not 76881.
    To dismiss the complete exam, 76881, as being equal to the old exam ignores the fact that
    a complete exam involves greater physician work to satisfy the elements inherent to a
    complete exam. This difference in work was acknowledged by the RUC during extensive
    compelling evidence discussions. The reference service and MPC codes selected were
    also evaluated by the RUC as being appropriate for codes 76881 and 76882 with regards
    to the work RVUs. The reference service code for 76881 was 76885 with MPC codes
    20610 and 11000. For code 76882, the reference service code was 76536 and MPC
    codes were 92083 and 11000.
    Using CMS’ logic, 76882 should have been the service which received the existing value
    of 0.59 RVU, rather than the 0.50 recommended by the RUC. Indeed, CMS’
    recommendation of the existing value for 76882 contradicts the concerns for survey bias
    discussed above. Based on CMS’ concerns for bias, we would have expected CMS to
    recommend a lower value than 0.59. We are confused by CMS’ inconsistent application
    of bias as an argument to invalidate the RUC’s recommendations. In any case, we
    respectfully ask that the codes 76881 and 76882 be evaluated through the refinement
    process since we are concerned that the CMS-promulgated interim values create rankorder anomalies not only within the family of ultrasound procedures, but also within the
    entire Physician Fee Schedule.

    RUC: Relative Value Scale Update Committee

About this Question

  • Posted by 3490 SuperCoder, 7 Year(s) ago. There are 5 posts. The latest reply is from SuperCoder.