CPT Code 76700: Complete Abdominal Ultrasound Billing Guide

76700 CPT Code Essentials

• CPT 76700 reports a complete abdominal ultrasound performed in real time with permanent image documentation. All 8 required structures must appear in the final report.
• The 8 structures are the liver, gallbladder, common bile duct, pancreas, spleen, both kidneys, upper abdominal aorta, and inferior vena cava.
• Missing one structure without a documented clinical reason drops the claim to CPT 76705, the limited study, at a lower payment.
• No modifier belongs on 76700 when one entity owns the equipment and interprets the study. Modifier 26 and modifier TC apply only when those components split between two entities.

Billers who look up the 76700 CPT code usually need three answers fast: what counts as complete, which modifier belongs on the claim, and what Medicare pays for it in 2026. This guide covers all three, along with the denial codes that surface when any of them go wrong.

Every section below answers one question about the 76700 CPT code. Skip to whichever one you came for.

What CPT Code 76700 Covers: The 8 Required Structures

The 8 Structures That Must Appear in the Report

1. Liver
2. Gallbladder
3. Common bile duct
4. Pancreas
5. Spleen
6. Both kidneys
7. Upper abdominal aorta
8. Inferior vena cava

Two of these go missing more than the rest. The common bile duct and the inferior vena cava get imaged during the scan, then don’t make it into the dictation. That gap turns a complete study into a limited one on paper, which is where the ultrasound abdomen CPT code selection breaks down.

Your sonographer probably captured the IVC. That isn’t the issue. The payer reviews the report, and a structure the radiologist didn’t dictate reads as a structure the sonographer didn’t image. Radiologists working from a dictation template written years ago are the usual source of the gap.

What CPT 76700 Does Not Cover

One correction is worth making, because a lot of published guidance has it backward. CMS Article A55336 states that a complete abdominal ultrasound views all structures in the abdomen, including those in the retroperitoneal area. Several billing guides claim the opposite. That error pushes coders toward billing a retroperitoneal code alongside 76700 when they shouldn’t.

Three things sit outside the code. The abdominal wall, the pelvis, and Doppler evaluation each carry their own CPT code. A liver-focused study is a common example: practices searching the CPT code for hepatic ultrasound land on 76700, but a single-organ liver scan routes to 76705 unless the full abdominal set gets documented.

The US abdomen complete CPT code and the CPT code for complete abdominal ultrasound describe the same service. Payers index them differently, and coders type them differently. The requirement doesn’t change.

Why Three Different Rules Decide Whether an Abdominal Ultrasound Is Complete

Rule 1: The 8-Element Test

The CPT descriptor and CMS coverage guidance both point to the same 8 structures listed above. Document all of them, or document a clinical reason for each one you couldn’t visualize, and the complete abdominal ultrasound CPT code applies.

Rule 2: The Quadrant Test

Noridian Part B guidance instructs that 76705 applies when a study covers one organ or a single quadrant, and that a single-quadrant study already includes all organs sitting in that quadrant. Once the sonographer evaluates organs from more than one quadrant, the CPT code for US abdomen complete becomes the correct selection.

The published example is useful. Spleen and stomach share a quadrant, so one unit of 76705 fits. Add the gallbladder from a different quadrant and the exam moves toward 76700.

Rule 3: The Retroperitoneal Inclusion Rule

Article A55336 states that the complete abdominal study already views retroperitoneal structures. That’s why CPT 76770, 76775, and 76776 are expected only when the exam stayed limited to retroperitoneal organs. You can confirm current policy in the Medicare Coverage Database.

How to Resolve the Three Rules on One Exam

1. Start with the order and the documented scope. Organs from more than one quadrant point toward 76700.
2. Check the report against the 8 required structures. All 8 present, or a documented clinical reason for each absent one, supports the ultrasound abdomen complete CPT code.
3. Fewer than 8 documented with no stated reason means the quadrant count doesn’t rescue the claim. Bill 76705.

The synthesis fits in one line: the quadrant test tells you which code the exam was heading toward, and the 8-element test tells you which code the report can support.

A practice manager reading three payer policies and getting three answers isn’t confused. The policies measure different things. Your report is the artifact a reviewer pulls two years later, so the documentation test wins whenever the tests disagree. That single distinction settles most US abdomen limited vs complete arguments before they start.

Working through abdominal ultrasound complete vs limited on a stack of old claims takes a chart-level review, not a policy read. Our pre-bill chart audits run reports against all three tests before claims go out.

CPT 76700 vs 76705: When a Complete Study Becomes a Limited One

When to Bill CPT 76705 Instead

Four scenarios cover most of the volume. A right upper quadrant study for gallbladder pain. A single-organ follow-up on a finding from a prior scan. A left upper quadrant look at the spleen. A point-of-care study answering one clinical question at the bedside.

The 76705 CPT code carries its own modifier rules, covered diagnoses, and 2026 rate. Our limited abdominal ultrasound billing guide handles the CPT code 76705 side in full, including the US abdomen limited CPT code selection for RUQ studies. The CPT code right upper quadrant ultrasound question resolves there too.

The Surgical Absence Exception

A patient with a prior cholecystectomy can still support 76700. Document the surgical history in the report and the missing gallbladder stops counting against you. The same logic covers a nephrectomy.

State the rule generally, because it applies past those two examples. A structure that can’t be imaged for a documented clinical reason doesn’t disqualify the complete code. Three reasons hold up: surgical absence, bowel gas, and body habitus. The reason has to sit in the report, not in someone’s memory.

Why Defensive Downcoding Is Also a Compliance Problem

Coders who default to the CPT code for limited abdominal ultrasound whenever a report looks thin haven’t solved anything. They’ve swapped an upcoding exposure for an underbilling one and written off revenue the practice earned. A limited abdominal ultrasound CPT code on a complete exam is still a coding error.

None of this is clinical judgment. Your coder reads the report, counts the structures, checks for stated reasons on the missing ones, and codes what the report supports. The same complete-versus-limited logic drives complete vs limited carotid billing, and the AAPC CPT code reference carries the current descriptor language.

Does CPT 76700 Need a Modifier?

The One-Question Decision Rule

Ask who owned the equipment on that date of service.

• Your practice owns it and your physician reads it: no modifier. Bill CPT 76700 globally.
• The hospital owns it and your physician reads it: modifier 26.
• You own it and someone else reads it: modifier TC.

That question settles the 76700 CPT code modifier decision on most claims. Our modifier 26 billing guide covers the PC/TC indicators, place-of-service rules, and date-of-service logic behind it, and the CMS Physician Fee Schedule database carries the indicator for every code.

Modifier 52, 59, 76, and 77 on Abdominal Ultrasound

CMS states that modifier 59 gets used incorrectly on a regular basis and should apply only when no more descriptive modifier fits. Treat it as a last option, not a default.

Both failure directions cost money. A practice that owns the machine and appends 26 out of habit gave away the technical payment. A radiology group reading on hospital equipment that bills globally might get paid, then face a recoupment once the hospital bills TC and the payer sees the overlap.

Radiologists reading across multiple sites need this tracked by location, not by physician. The same doctor can require different modifiers on the same day, and abdominal ultrasound CPT claims are where that shows up first. Our radiology billing services handle the component split by site of service.

Can You Bill CPT 76700 and 93975 Together?

What CPT 93975 and 93976 Cover

Most published guidance names 93975 as though it were the only abdominal duplex code. The 93976 CPT code covers the limited study, and picking the wrong one of the pair produces the same downcode problem that 76700 and 76705 produce. The 93976 CPT code description turns on scope, same as the grayscale pair. ACR coding guidance carries the current definitions.

When Both Codes Are Separately Payable

Portal hypertension is the clean example. The radiologist evaluates portal venous flow with Doppler alongside a complete grayscale abdominal survey. Two clinical questions, two documented services, two codes.

Both failure modes cost the practice.

• Billing 76700 alone when the sonographer performed Doppler leaves earned revenue unbilled.
• Billing 93975 without checking the edit and supporting a distinct indication invites a bundling denial.

Practices running vascular assessment alongside abdominal imaging lose the duplex payment quietly, claim after claim, because the coder sees one order and bills one code.

The same pattern shows up on CPT 93970 venous duplex claims and on arterial duplex NCCI pairing reviews. A liver study makes it concrete: the CPT code liver ultrasound question and the liver US CPT code question both change once Doppler enters the exam.

Can CPT 76700 and 76770 Be Billed Together?

Why the Two Codes Overlap

The 76700 CPT code already includes the kidneys, the upper abdominal aorta, and the inferior vena cava. Those are the same structures the 76770 CPT code evaluates. Supporting both on one session would require double-imaging the shared structures and documenting each set separately.

The Recoupment Risk Most Guides Get Wrong

No PTP edit means no automated denial. The claim adjudicates and it pays. The prohibition on CPT code 76770 alongside a complete abdominal study is a coverage and medical-necessity rule, and reviewers enforce it retrospectively.

A practice billing this pair routinely watches clean payments post for months, then receives a recoupment demand covering all of them. Payment tells you the claim passed an automated edit. It says nothing about whether the documentation survives a chart review two years later.

The CMS NCCI PTP edits page shows which pairs carry an edit, and our CO-236 NCCI edit guide covers the ones that do.

The Narrow Cases Where Both May Be Reported

Two situations can support both codes. Separately ordered studies addressing distinct medically necessary questions. Exams performed in different sessions on the same calendar day, documented separately, with a distinct procedural modifier where the payer requires one.

Some commercial payers maintain their own bundling rules independent of NCCI, so a retroperitoneal ultrasound CPT code pairing that clears Medicare can still deny commercially. The US retroperitoneal complete CPT code question is worth checking payer by payer. When a recoupment letter does arrive, our appeal and recoupment support team works the response.

The Full Abdominal Ultrasound Code Family: 76700 to 76776

CPT 76706 for Abdominal Aortic Aneurysm Screening

CPT 76706 covers screening only. Medicare pays it as a screening benefit with a referral requirement, and it stays outside a diagnostic exam even when the aorta is the clinical concern.

Coders searching the CPT code for aortic ultrasound or the US abdominal aorta CPT code often land on 76706 when the encounter was diagnostic. That routes the claim to the wrong code and the wrong coverage rule.

The abdominal aortic ultrasound CPT code question comes down to intent. Screening goes to 76706. A diagnostic aortic assessment inside a full abdominal survey stays inside 76700.

CPT 76770 and 76775 for Retroperitoneal Studies

A complete retroperitoneal study requires both kidneys, the abdominal aorta, the common iliac artery origins, the inferior vena cava, and any visible retroperitoneal abnormality. The CPT code 76775 and 76775 CPT code variants cover the limited version. US retroperitoneal limited studies follow the same scope logic as the abdominal pair. Coverage sits in Medicare LCD L34577.

The Urinary Tract Pathology Exception

An evaluation of the kidneys and the urinary bladder also qualifies as a complete retroperitoneal study when the clinical history indicates urinary tract pathology such as flank pain, hematuria, or stones. Few billing guides publish this, and it changes the answer on renal studies.

One modifier note belongs here. Don’t append modifier 50 to 76770. The code covers both kidneys by definition, and adding a bilateral modifier triggers a denial.

Codes That Cannot Be Billed Together

CPT 76700 and 76705 can’t both be reported for exams performed in the same session. Additional structures imaged during a complete exam are included in 76700 and aren’t separately reportable.

Coders who know only 76700 and 76705 misroute AAA screenings and renal transplant studies. Both mistakes are recoverable revenue sitting in old claims.

What Is the LCD for CPT Code 76700?

Why 76700 Has No Dedicated LCD

LCDs attach to services where a contractor has published coverage criteria. Not every CPT code gets one. A biller searching for the LCD on the 76700 CPT code finds L34577 and reasonably assumes it governs the abdominal code. It doesn’t. L34577 governs 76770, 76775, and 76776, and it mentions 76700 to draw the boundary between them.

Which Coverage Documents Govern the Code

• The ICD-10 diagnosis supporting medical necessity for that encounter
• CMS Article A55336, for the abdominal versus retroperitoneal boundary
• Your MAC’s own policy for the jurisdiction and the date of service
• Commercial payer medical policy, which operates separately from Medicare

How to Check Coverage for Your MAC Jurisdiction

Search the CMS Medicare Coverage Database by code and by contractor, not by code alone. A policy that exists in one jurisdiction may not exist in another. Our MAC jurisdiction coverage rules breakdown shows how the same logic plays out on cardiac imaging, where one contractor publishes an article and another doesn’t.

A biller who assumes a national LCD exists builds a covered-diagnosis list from the wrong document. Claims then deny in one state and pay in another, and your team can’t explain the split until someone checks the contractor for that date of service.

ICD-10 Codes That Support Medical Necessity for CPT 76700

Common Covered Diagnoses

Why the Diagnosis Has to Match the Order, Not the Finding

The medical necessity diagnosis comes from the physician’s order and documented indication, not from what the ultrasound found. If the order says abdominal pain and the study finds fatty liver, the code on the claim is the pain. Billing the finding creates a mismatch the payer’s edit engine catches, and it arrives back as a CO-11 diagnosis mismatch.

A diagnosis that fails the coverage policy comes back differently. Those land as CO-50 medical necessity denials, and the fix runs through the covered-diagnosis list for that jurisdiction rather than through the coding. Imaging coverage works this way across modalities, and our screening mammography coverage rules guide walks the same NCD and LCD structure on a screening code.

Frequency Limits on Repeat Studies

Repeat studies under the same diagnosis draw scrutiny. A patient scanned six months ago needs new clinical documentation, new symptoms, new labs, or a change in findings before a repeat claim survives review. The same ICD-10 code with no new chart notes gets flagged.

Most of this traces back to scheduling. Somebody captures the indication when the appointment gets booked, not when the claim gets coded. An order that arrives saying abdominal pain and nothing else leaves your billing team reconstructing medical necessity from a scan report after the fact. That’s backward, and it costs money on every claim it touches.

Documentation Requirements That Protect a 76700 Claim

The Six Elements Every 76700 Report Needs

1. Clinical indication that matches the ICD-10 code on the claim
2. Organ-by-organ findings covering all 8 required structures
3. A stated reason for any structure the sonographer couldn’t visualize
4. Real-time imaging with permanent image retention, meaning stored images a reviewer can pull
5. The interpreting physician’s signature on the final report
6. A date of service on the claim that matches the interpretation

The AIUM practice parameter for abdominal and retroperitoneal ultrasound calls for a permanent record of the examination, images of all appropriate areas both normal and abnormal, measurements accompanying size variations, labeling with patient identification and side, and a final interpretation in the medical record. ACEP ultrasound guidance describes the same complete-versus-focused distinction from the clinical side.

How to Document a Structure That Could Not Be Visualized

Three reasons hold up on review: surgical absence, bowel gas, and body habitus. The report names which structure, which reason, and that the sonographer attempted it. A line reading that the pancreatic tail was obscured by overlying bowel gas and visualization was limited does the job.

A report reading “abdominal ultrasound performed, findings as above” doesn’t support the abdominal ultrasound CPT code at the complete level. Reviewers downgrade it, and the denial comes back as a CO-16 documentation denial.

Silence in the report reads as non-performance to a payer reviewer. Your sonographer may have imaged the inferior vena cava cleanly. If the radiologist didn’t dictate it, the claim can’t prove it happened, and the complete abdominal ultrasound CPT code stops being defensible. Our imaging documentation review catches the gap before the claim ships.

76700 CPT Code Reimbursement: 2026 Medicare Rates and RVUs

The Two Conversion Factors Introduced in 2026

The CY 2026 Physician Fee Schedule final rule (CMS-1832-F), issued October 31, 2025 and effective January 1, 2026, established two conversion factors: $33.57 for qualifying APM participants and $33.40 for non-qualifying participants, up from a single $32.35 in CY 2025.

Two practices billing identical 76700 claims in the same locality can receive different Medicare payments in 2026 based on APM status alone. Most diagnostic imaging practices can’t participate in an APM, so the $33.40 rate applies to the majority of these claims.

One offset matters. CMS applied a 2.5% efficiency adjustment to work RVUs for non-time-based services, which covers diagnostic radiology. The conversion factor increase and the work RVU reduction move in opposite directions, so a 2025 payment figure won’t carry forward cleanly.

Work RVU and Total RVU for 76700

The 76700 CPT code carries a work RVU of 0.79 under the 2026 Medicare Physician Fee Schedule. The non-facility practice expense RVU sits at 2.57 and the malpractice RVU at 0.06, which puts the non-facility total at 3.42 RVUs.

That national figure runs before geographic adjustment. Your locality moves it. Run your own GPCI values through the CMS Physician Fee Schedule Look-Up Tool before using any number for a budget or a contract conversation.

Facility Versus Non-Facility Payment

The non-facility rate applies in a freestanding imaging center or a physician office, where the practice carries the overhead. The facility rate applies in a hospital outpatient department, where Medicare pays the facility separately through the outpatient system.

CMS changed that relationship for 2026. Facility practice expense RVUs allocated on work RVUs drop to half the non-facility allocation, which widens the gap between the two settings. Check the facility figure for your own setting instead of assuming it matches the non-facility number.

Several published RVU tables still show facility and non-facility totals as identical for this code. That stopped being accurate in 2026. Pull the current value rather than trusting a table that hasn’t been updated.

What the Complete-to-Limited Downcode Costs

Work RVU for CPT 76700 is 0.79. Work RVU for CPT 76705 is 0.58. A complete study that downcodes to limited loses roughly 27% of its work value, before the practice expense difference gets counted on top.

One downcode doesn’t register on a monthly report. A pattern does. Run that gap against a practice performing twenty abdominal ultrasounds a week with a documentation problem on even one in six, and the annual figure stops being a rounding error.

That math is also the argument for fixing the dictation template rather than appealing claim by claim. Appeals recover one claim. A template fix recovers every claim after it.

Commercial Payer Rates and Why They Vary So Widely

How Commercial Rates Compare to Medicare

Commercial allowed amounts for the 76700 CPT code run above the Medicare national figure in most markets, and the distance between the highest and lowest payer in one market is wide enough to change a practice’s imaging margin.

Payers publish their negotiated rates in machine-readable files under the federal transparency rules, so your own numbers are available without guessing. CMS price transparency resources explain where those files sit and how to read them.

Pull your top four payers, filter for 76700, and line the results up against the Medicare figure from the section above. That comparison takes an afternoon and it answers whether your contract is competitive or whether it has been sitting untouched since somebody signed it.

Why Two Practices Bill the Same Code and Get Different Amounts

• Contract terms negotiated at the practice or group level
• Geographic locality and the payer’s regional fee schedule
• Place of service on the claim
• In-network versus out-of-network status
• Whether the claim went out globally or split into components

A practice that hasn’t benchmarked its CPT 76700 rate against its own market has no way to know whether the contract is competitive. Most haven’t looked.

Rate benchmarking is a contract conversation, not a coding conversation. The billing team can code every claim correctly and still collect below market because the practice hasn’t renegotiated in four years. Our revenue cycle management services team runs the comparison as part of account review.

Why CPT 76700 Claims Get Denied and How to Fix Each One

The Six Denial Codes That Hit Abdominal Ultrasound Claims

Authorization failures on imaging have their own workflow, and our CO-197 authorization denials playbook covers the eight operational triggers behind them.

How to Prevent the Downcode Before the Claim Goes Out

1. Count the documented structures against the required 8
2. Confirm every absent structure carries a stated clinical reason
3. Verify the diagnosis matches the physician’s order
4. Confirm the modifier matches equipment ownership for that date of service
5. Check any same-day imaging pair against the current quarter’s NCCI file

CMS updates procedure-to-procedure edits and medically unlikely edits quarterly. The Q3 2026 files took effect July 1, 2026 and were posted June 1, 2026. A pairing that was payable in one quarter can trigger an edit in the next.

One CMS rule catches teams off guard. CMS states that some medically unlikely edit values are confidential and aren’t published, so the absence of a published MUE doesn’t indicate the absence of an edit. Teams that build a units-of-service check off the published table alone will miss the confidential ones.

Preventing a 76700 CPT code downcode isn’t a coding skill. It’s a documentation review that happens before the claim ships, and most practices haven’t assigned it to anyone. Our specialty-matched imaging coders run that check as a standing step, not as cleanup after a denial lands.

What Changed for Abdominal Ultrasound Billing in 2026

• The 76700 CPT code is unchanged. Its descriptor and required elements carry forward into 2026 exactly as written.
• New codes landed nearby. Six new Category I codes in the 76014 to 76019 range address MRI safety assessment for implanted devices. Different modality, adjacent numbering, worth knowing for a radiology charge master.
• The payment framework changed, not the code. Dual conversion factors and the 2.5% work RVU efficiency adjustment are the material 2026 changes affecting what 76700 collects.
• NCCI edits still update quarterly. Q3 2026 files took effect July 1, 2026, and the next set replaces them on schedule.

The code didn’t change. The money around it did. That’s the update your practice needs to act on before someone builds a 2026 budget off last year’s collections.

Frequently Asked Questions About CPT Code 76700

What is CPT code 76700 used for?

CPT code 76700 reports a complete abdominal ultrasound performed in real time with permanent image documentation. The report must cover eight structures: the liver, gallbladder, common bile duct, pancreas, spleen, both kidneys, upper abdominal aorta, and inferior vena cava. Physicians order it for abdominal pain, abnormal liver enzymes, suspected gallstones, and follow-up on findings from prior imaging. It’s one of the highest-volume radiology codes in outpatient billing, which also makes it one of the most frequently downcoded when documentation falls short.

What is the difference between CPT 76700 and 76705?

CPT 76700 covers a complete study with all eight required structures documented. CPT 76705 covers a limited study of one organ or one quadrant, such as a right upper quadrant look at the gallbladder. The distinction runs on documentation, not clinical judgment. If the report omits even one required structure and gives no clinical reason for the omission, the claim belongs on 76705. Billing 76700 anyway is an upcoding pattern that automated audit tools are built to find.

Does CPT 76700 need a modifier?

Only when two different entities bill the professional and technical components. If your practice owns the ultrasound equipment and your physician interprets the study, bill 76700 with no modifier at all. CMS reads a blank modifier field as the global service. Append modifier 26 when your physician interprets a study performed on equipment someone else owns. Append modifier TC when you own the equipment and a different physician reads the study. Check equipment ownership for that specific date of service, since it can change by location.

Can 76700 and 76770 be billed together?

Generally no. CMS Article A55336 expects retroperitoneal codes only when the exam stayed limited to retroperitoneal structures, and CPT 76700 already covers the kidneys, aorta, and inferior vena cava. There’s no NCCI procedure-to-procedure edit between the two codes, which means the claim will often pay at adjudication. The exposure shows up later as a post-payment recoupment. Both codes can be reported when separately ordered studies address distinct medically necessary questions, with documentation supporting each one.

Can you bill 76700 and 93975 together?

Yes, when the duplex study answers a clinical question the grayscale exam doesn’t. The 76700 CPT code doesn’t include Doppler, so a duplex evaluation of the abdominal vessels is reported separately using CPT 93975 for a complete study or CPT 93976 for a limited one. Portal hypertension evaluated alongside a complete grayscale survey is the standard example. Check the current NCCI edit and its modifier indicator before submitting both, and document a distinct indication for each service.

What ICD-10 codes support CPT 76700?

Common pairings include R10.9 for unspecified abdominal pain, K80.20 for gallstones without cholecystitis, K76.0 for fatty liver, R74.01 for elevated liver transaminases, R16.0 for hepatomegaly, and R93.5 for abnormal abdominal imaging findings. Select the most specific code the record supports. The diagnosis has to match the physician’s order and documented indication, not the finding the ultrasound produced. Covered diagnosis lists vary by Medicare Administrative Contractor and by commercial payer, so confirm the list for your jurisdiction.

What is the LCD for CPT code 76700?

CPT 76700 has no dedicated Local Coverage Determination in most Medicare jurisdictions. LCD L34577 covers retroperitoneal ultrasound and governs CPT 76770, 76775, and 76776, referencing 76700 only to draw the boundary between abdominal and retroperitoneal studies. Coverage for a complete abdominal ultrasound runs on the ordering diagnosis, documented medical necessity, and your MAC’s own policy for the date of service. Search the Medicare Coverage Database by code and by contractor rather than by code alone.

Why was my abdominal ultrasound claim downcoded to 76705?

The usual cause is a required structure missing from the report with no clinical reason stated. Reviewers accept three reasons for non-visualization: surgical absence such as a prior cholecystectomy, bowel gas obscuring the view, and body habitus limiting penetration. The report has to name the structure, name the reason, and show the sonographer attempted it. A report that lists seven of eight structures and says nothing about the eighth supports the limited code, regardless of what the sonographer imaged.

Most of the revenue that leaks out of a 76700 claim leaves through documentation. The structures get imaged. The report doesn’t carry them, the modifier doesn’t match the equipment, or the diagnosis doesn’t match the order.

One O Seven RCM works those checkpoints before claims go out, across radiology, imaging centers, and the specialties that order abdominal ultrasound every week.