Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

76856+76830

Pessie Posted Wed 01st of May, 2013 20:12:48 PM

MOST INSURANCES DENY 76856+76830 WITHOUT A 59. HOWEVER, SUPERCODER DOES NOT SHOW THAT IN CCI EDIT CHECKER. HOW DO WE DETERMINE THE NEED OF THE MODIFIER? THANK YOU

SuperCoder Answered Wed 01st of May, 2013 21:05:56 PM

You may code for both ultrasounds as long as they are both medically necessary and ordered by the gynecologist.

Report 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) and 76830 (Ultrasound, transvaginal). Depending on your payer’s rules, you may need to append modifier 51 (Multiple procedures) to 76830.

Why: CPT guidelines say that if you perform a transvaginal examination in addition to a transabdominal nonobstetric ultrasound, you should report 76830 in addition to the appropriate transabdominal exam code. Remember: CMS requires that the treating physician--in this case, the gynecologist--order diagnostic tests. The request and report should convey the medical necessity for both exams.

Related Topics