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U/S billing for Infertility

Michelle Posted Wed 10th of June, 2020 18:23:51 PM
We monitor female pelvis for diagnosis and treatment for Infertility. During the monitoring and treatment cycles, Dr. does a transvaginal scan to measure the uterus and note position, ovarian size, presence of fibroids or polyps and follicle development. During treatment he monitors every other day the growth of the follicles while on medication and the development of the uterine stripe for implantation purposes. He measures each and every follicle, sometimes up to 20 and takes pictures of lead follicle development for the record. Is it correct to use 76830 to denote the transvaginal approach and measurement of pelvic organs along with the 76857 to denote the individual measurement and pictures of the individual follicles.
SuperCoder Answered Thu 11th of June, 2020 03:32:02 AM

Hi Michelle,

Hope you are keeping well.

In CPT 76830 (Ultrasound, transvaginal), the provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient to assess the patient for correct diagnosis. Whereas, in CPT 76857 {Ultrasound, pelvic (non-obstetric), real time with image documentation; limited or follow-up (eg, for follicles)}, a noninvasive pelvic ultrasound procedure is performed to assess one or more pelvic structures, such as bladder, ovaries, uterus, cervix, and fallopian tubes in females and the bladder, prostate gland, and seminal vesicles in males.

Both the ultrasounds can be coded as long as they both are medically necessary and ordered by the provider. While report 76857 and 76830, depending on your payer’s rules, you may need to append modifier 51 (Multiple procedures) to 76857.

In addition to it, CPT guidelines say that if you perform a transvaginal examination in addition to a transabdominal non-obstetric ultrasound, you should report 76830 in addition to the appropriate transabdominal exam code. Although, if you choose to report 76830 for checking follicles you MUST document all of the structures, not just the follicles to qualify for this code. Also, 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.

Hope this helps!

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