Local Coverage Article Billing and Coding

Billing and Coding: Ultrasound, Soft Tissues of Head and Neck

A57029

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Contractor Information

Article Information

General Information

Article ID
A57029
Article Title
Billing and Coding: Ultrasound, Soft Tissues of Head and Neck
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34027, Ultrasound, Soft Tissues of Head and Neck. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
76536 Us exam of head and neck

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(80 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 76536

Group 1 Codes
CodeDescription
C47.0 Malignant neoplasm of peripheral nerves of head, face and neck
C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck
C73 Malignant neoplasm of thyroid gland
C74.00 Malignant neoplasm of cortex of unspecified adrenal gland
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.10 Malignant neoplasm of medulla of unspecified adrenal gland
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C74.90 Malignant neoplasm of unspecified part of unspecified adrenal gland
C74.91 Malignant neoplasm of unspecified part of right adrenal gland
C74.92 Malignant neoplasm of unspecified part of left adrenal gland
C75.0 Malignant neoplasm of parathyroid gland
C75.4 Malignant neoplasm of carotid body
C76.0 Malignant neoplasm of head, face and neck
C77.0 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
C83.11 Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.31 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.51 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck
C84.41 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.61 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.71 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C85.21 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck
D09.3 Carcinoma in situ of thyroid and other endocrine glands
D09.8 Carcinoma in situ of other specified sites
D21.0 Benign neoplasm of connective and other soft tissue of head, face and neck
D34 Benign neoplasm of thyroid gland
D35.1 Benign neoplasm of parathyroid gland
D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
E01.0 Iodine-deficiency related diffuse (endemic) goiter
E01.1 Iodine-deficiency related multinodular (endemic) goiter
E01.2 Iodine-deficiency related (endemic) goiter, unspecified
E03.4 Atrophy of thyroid (acquired)
E04.0 Nontoxic diffuse goiter
E04.1 Nontoxic single thyroid nodule
E04.2 Nontoxic multinodular goiter
E04.8 Other specified nontoxic goiter
E04.9 Nontoxic goiter, unspecified
E05.00 Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm
E05.01 Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
E05.10 Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm
E05.11 Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm
E05.20 Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm
E05.21 Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm
E05.30 Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or storm
E05.31 Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or storm
E05.40 Thyrotoxicosis factitia without thyrotoxic crisis or storm
E05.41 Thyrotoxicosis factitia with thyrotoxic crisis or storm
E05.80 Other thyrotoxicosis without thyrotoxic crisis or storm
E05.81 Other thyrotoxicosis with thyrotoxic crisis or storm
E05.90 Thyrotoxicosis, unspecified without thyrotoxic crisis or storm
E05.91 Thyrotoxicosis, unspecified with thyrotoxic crisis or storm
E06.0 Acute thyroiditis
E06.1 Subacute thyroiditis
E06.9 Thyroiditis, unspecified
E07.0 Hypersecretion of calcitonin
E07.1 Dyshormogenetic goiter
E07.89 Other specified disorders of thyroid
E07.9 Disorder of thyroid, unspecified
E21.4 Other specified disorders of parathyroid gland
E35 Disorders of endocrine glands in diseases classified elsewhere
K12.2 Cellulitis and abscess of mouth
L02.01 Cutaneous abscess of face
L02.11 Cutaneous abscess of neck
L03.211 Cellulitis of face
L03.212 Acute lymphangitis of face
L03.213 Periorbital cellulitis
L03.221 Cellulitis of neck
L03.222 Acute lymphangitis of neck
Q89.2 Congenital malformations of other endocrine glands
R22.0 Localized swelling, mass and lump, head
R22.1 Localized swelling, mass and lump, neck
R59.0 Localized enlarged lymph nodes
R59.1 Generalized enlarged lymph nodes
R59.9 Enlarged lymph nodes, unspecified
R90.0 Intracranial space-occupying lesion found on diagnostic imaging of central nervous system
R94.6 Abnormal results of thyroid function studies
Z85.850 Personal history of malignant neoplasm of thyroid
Z92.3 Personal history of irradiation

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes
CodeDescription
XX000 Not Applicable

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R2

Article revised and published on 11/03/2022 effective for dates of service on and after 10/01/2022 to reflect the title of the LCD L34027 listed under the 'Article Text'.

10/01/2022 R1

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code description has changed: C84.41 in ‘Group 1 Codes’. Formatting changes have been made throughout the article. A reference to the Social Security Act has been added to the ‘CMS National Coverage Policy' section and formatting changes have been made throughout the article.

Associated Documents

Related Local Coverage Documents
LCDs
L34027 - Ultrasound, Soft Tissues of Head and Neck
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
10/28/2022 10/01/2022 - N/A Currently in Effect You are here
10/14/2022 10/01/2022 - N/A Superseded View
09/18/2019 10/03/2018 - 09/30/2022 Superseded View

Keywords

N/A