Q: I have a new ultrasound machine that applies the ultrasound without anyone present but the patient. It works by a "pulse" that allows me to set the sound head with a mechanical arm and leave the patient unattended during the time of the service. Can I bill the regular ultrasound code of 97035 or do I need to bill with an alternate CPT code?
A: This type of ultrasound has become available and more popular with technology that allows an ultrasound head to remain in a single position and deliver its treatment without the harm of burning or over-exposure. However, billing for this type of ultrasound service does not comply with the coding requirement of the 97035 CPT code.
CPT code 97035, ultrasound, is defined as a constant-attendance modality wherein there is direct, one-on-one contact by the provider during the delivery of the service. Because of its constant-attendance requirement, 97035 is billable in units based on each 15 minutes of application. (For information on billing units and the specific time requirements, please see "Billing Units of Service: The Element of Time" in the April 23, 2007 issue of Dynamic Chiropractic).
Because of the constant-attendance requirement, it would not be appropriate to bill this type of ultrasound service under the 97035 code since the code requires that the provider remain in contact with the patient throughout the entire procedure. This constant contact is, of course, a requirement for standard ultrasound due the sound head being hand-held and needing continuous motion during application of the therapy.
That said, unattended ultrasound is still a billable service, but not with the code 97035. Billing for unattended ultrasound would be accomplished via CPT code 97039, which is for an unlisted modality. And because 97039 is an unlisted service, it requires an explanation of the service with the billing. This can be done in two ways. The first and most obvious way is to send additional documentation that the unlisted service coded on the 1500 is for unattended ultrasound. However, it can also be documented on the 1500 in section 24, where the date of service and billing code are placed. On each line of billing for the 1500, there is the white section where the specific date of service and billing codes are identified, but there is also a pink shaded area above the white region where information on the unlisted service can be indicated.
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