CPT Code for Liver Ultrasound Monitoring in Cirrhosis
The CPT code for ultrasound monitoring of the liver in a patient with cirrhosis is 76700 (Ultrasound, abdominal, real time with image documentation; complete) or 76705 (limited), depending on whether a complete or limited examination is performed.
Standard Surveillance Protocol
Patients with cirrhosis require ultrasound surveillance every 6 months for hepatocellular carcinoma (HCC) screening. 1, 2 This recommendation is based on the American Association for the Study of Liver Diseases guidelines, which establish ultrasound as the primary surveillance modality for HCC detection in cirrhotic patients. 1, 2
CPT Code Selection
CPT 76700 is used for a complete abdominal ultrasound with real-time imaging and documentation, which includes comprehensive evaluation of the liver, gallbladder, bile ducts, pancreas, spleen, and kidneys. 3
CPT 76705 is used for a limited ultrasound examination focused specifically on the liver when a complete abdominal survey is not clinically indicated.
The choice between complete versus limited examination depends on whether you need to assess for cirrhosis complications (ascites, splenomegaly, portal hypertension) or are performing focused HCC surveillance only.
Important Coding Considerations
When ultrasound quality is inadequate, alternative imaging must be pursued. 1, 3, 2 The American College of Radiology specifically notes that ultrasound is particularly limited in patients with obesity, nonalcoholic fatty liver disease, and nodular cirrhotic livers. 1, 3 In these populations, multiphase CT (CPT 74170) or MRI (CPT 74181-74183) should be considered instead. 1, 2
Additional Codes That May Apply
CPT 91200 (Liver elastography) may be added when assessing fibrosis progression, though this is typically not part of routine HCC surveillance. 1
Alpha-fetoprotein (AFP) testing (CPT 82105) is optional but commonly added to ultrasound surveillance, though guidelines consider it adjunctive rather than mandatory. 1
Common Pitfalls to Avoid
Do not accept "limited visualization" reports without follow-up imaging. 3, 2 When radiologists report inadequate visualization, you must pursue CT or MRI to avoid missing early HCC, as ultrasound sensitivity drops to only 47% for early-stage disease. 2
Do not extend surveillance intervals beyond 6 months. 1, 2 This is the evidence-based standard for all cirrhotic patients regardless of etiology or other risk factors.
Recognize that ultrasound has inherent limitations - it achieves only 65-80% sensitivity for HCC detection overall and cannot reliably diagnose earlier stages of fibrosis. 1, 2