In all my 7 years of coding for ENT, this is the first time I’m coming across this and I wanted to know if what is being done is tip-toeing on the edge of over-utilization or not medically necessary….

Endo surgeon performs thyroidectomies and lobectomies all the time without any intraoperative ultrasound. All of the sudden now EVERY single case has included 76536 (Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation) and I’m concerned that this is not medically necessary. I haven’t been able to find a single scholarly article, coding article, or even Physician membership board mentioning that this is somehow routine (or even a new way of performing the surgery). I’ve worked with 2 different ENT groups and this is the first time I’m seeing them bill for 76536; 1-2 cases here and there, I can understand…this is literally every single patient on their list all of sudden.

Most of the documentation is verbatim in every op report and reads: "After induction of general endotracheal anesthesia, Intraoperative neck sonography was performed for incision site planning and to rule out interval development of malignant adenopathy or extrathyroidal extension of tumor. The patient was then prepped…"