Understanding the American Medical Associations (AMA) position on certain ob-gyn ultrasounds conducted on the same day can be key to appealing a denial.
One major issue revolves around whether or not transvaginal ultrasounds (CPT 76830 , echography, transvaginal) may legitimately be performed on the same patient on the same day that a standard pelvic ultrasound is conducted (using the transabdominal approach). Although the AMA has clearly indicated that it is frequently appropriate to conduct both ultrasounds on a patient during the same session or on the same day, some carriers are refusing to pay for the transvaginal approach.
Because transabdominal and transvaginal approaches allow a radiologist to view many of the same organs, payers sometimes argue that there should be no need for both to be performed the same day on the same patient. Their rationale is based on definitions such as the one that appears in the American College of Radiologys (ACR) Ultrasound Guidelines, which describe a transabdominal pelvic ultrasound as studying the uterus, ovaries and adnexa. The transvaginal approach is described as examining the uterus, endometrium, ovaries and adnexavirtually the same organs. Other payers argue that transvaginal echography is included as part of a complete pelvic ultrasound examination.
The AMA has stated that the two approaches describe distinct studies and that the services performed for the transvaginal echography are not included as part of the pelvic ultrasound examination. Both are necessary to making accurate diagnoses in many instances.
Although both types of ultrasound view mainly the same organs, the transvaginal approach allows a more precise field for examination, explains Rob Levin, CHBME, chief operating officer for Billing Solutions Inc. in Newtown, Pa., a firm that provides medical billing services to one of the countrys largest ultrasound companies. You can visualize more detailed anatomy, but there is some sacrifice due to a narrower field of view.
Two Services, Two Codes
A patient may be referred for an ultrasound because of unusual menstrual bleeding (626.2). A standard transabdominal pelvic ultrasound is performed and the technician identifies a small uterine mass that may be contributing to the womans condition. However, he is unable to get a clear view because of the location of the mass. He then utilizes a transvaginal approach to get a more precise image of the abnormality. Under these circumstances, the study would be assigned 76856 (echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) and 76830-51. The -51 modifier (multiple procedures) is added to describe the transvaginal ultrasound as the secondary, additional service.
Another typical example of a transvaginal approach occurs when [...]