2025 CPT code 76775
Effective Date: N/A Revision Date: N/A Radiology - Diagnostic Ultrasound Feed
Limited retroperitoneal ultrasound, using real-time imaging with documentation.
Modifiers may be applicable. Modifier 26 is used for the professional component, and TC is used for the technical component. Modifier 59 may be necessary to distinguish this limited exam from a complete exam performed during the same encounter. Other modifiers may be applicable based on specific circumstances.
Medical necessity for this code must be established by the patient's signs, symptoms, or other diagnostic findings that justify a focused assessment of a limited portion of the retroperitoneum. Specific symptoms may include flank pain, hematuria, abnormal lab values, palpable masses, etc. Previous imaging studies may also provide the medical necessity.
The physician or a qualified technician performs the ultrasound. This involves applying gel to the patient's skin, placing the transducer (wand) on the body, and maneuvering it to visualize and capture real-time images of the retroperitoneal structures. A written report interpreting the findings is included in the patient record. For services provided in a physician's office, the physician typically performs the real-time scan and documents the findings.
In simple words: A limited ultrasound uses sound waves to create pictures of specific areas behind your belly, like your kidneys or aorta. The doctor moves a wand over your skin, and the images appear on a screen. This helps check those areas if you have problems like pain or abnormal tests. It's a safe and painless way for the doctor to see what's going on inside.
This code refers to a limited ultrasound examination of the retroperitoneal area, which includes structures like the kidneys, abdominal aorta, and in some cases when urinary tract issues are suspected, the urinary bladder. It involves capturing and documenting real-time images during the procedure. This is different from a complete retroperitoneal ultrasound (76770) which examines a wider range of structures.
Example 1: A patient presents with right flank pain and hematuria. A limited retroperitoneal ultrasound (76775) is ordered to assess the right kidney for abnormalities such as stones or masses., A patient with a history of hypertension needs an evaluation of their kidneys. A limited retroperitoneal ultrasound (76775) is performed to assess kidney size and structure., A patient is being monitored for an abdominal aortic aneurysm. A limited retroperitoneal ultrasound (76775) focused on the aorta is performed to measure its diameter.
Documentation should include the reason for the exam, real-time images taken during the procedure, measurements of any relevant structures, and a final written report summarizing the findings and any relevant diagnoses. If the bladder is examined due to urinary tract concerns, this should also be documented.
- Modifier TC rule: Modifier TC can be used when only the technical component of the procedure is being billed (e.g., by the facility providing the equipment and technician).
- Specialties:Radiology, Urology, Nephrology, Internal Medicine, Emergency Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic, Mobile Unit, and other applicable facilities.