Outline Coding Resources - IAME · Personal Supervision of Gyn US • Sonohysterography(ultrasound) ... education beyond residency that is acquired in a fellowship in Maternalacquired

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Coding in ObCoding in Ob--Gyn UltrasoundGyn Ultrasound

James M. Shwayder, M.D., J.D.James M. Shwayder, M.D., J.D.Professor and ChairProfessor and Chair

Department of Obstetrics and Gynecology Department of Obstetrics and Gynecology University of MississippiUniversity of Mississippi

Jackson, MississippiJackson, Mississippi

Coding in ObCoding in Ob--Gyn UltrasoundGyn Ultrasound

James M. Shwayder, M.D., James M. Shwayder, M.D., J.D.J.D.

Disclosures:Disclosures: NoneNone

OutlineOutline

•• CPT codingCPT coding

•• ICDICD--9 and ICD9 and ICD--1010

•• Supervision requirementsSupervision requirements•• Supervision requirementsSupervision requirements

•• Appropriate documentation and codingAppropriate documentation and coding

•• Obstetrical ultrasoundObstetrical ultrasound

•• Gynecologic ultrasoundGynecologic ultrasound

•• 3D/4D sonography3D/4D sonography

Coding ResourcesCoding Resources

•• ProceduresProcedures•• Current Procedural TerminologyCurrent Procedural Terminology•• CPTCPT®® 20162016•• CPTCPT® ® 20162016

•• DiagnosisDiagnosis•• International Classification of International Classification of

Diseases Diseases •• ICDICD--1010--CM CM

•• ResourcesResources•• ACOG, AMA, AIUMACOG, AMA, AIUM

Procedural CodingProcedural Coding

•• CPT book sets the rulesCPT book sets the rules

•• Descriptions are imperfectDescriptions are imperfect

ICDICD--1010--CM CM Diagnosis CodingDiagnosis Coding

•• Diagnostic services during an encounter/visitDiagnostic services during an encounter/visit•• Sequence: diagnosis, condition, problem, or other Sequence: diagnosis, condition, problem, or other

reason (symptom) for encounter/visitreason (symptom) for encounter/visit

O t ti t t f di ti t t dO t ti t t f di ti t t d•• Outpatient encounters for diagnostic tests and Outpatient encounters for diagnostic tests and procedures and the final report is available at the procedures and the final report is available at the time of codingtime of coding•• Code any confirmed or definitive diagnosis Code any confirmed or definitive diagnosis

documented in the interpretationdocumented in the interpretation. .

•• Do not code related signs and symptoms as additional Do not code related signs and symptoms as additional diagnosisdiagnosis

www.cdc.gov.nchswww.cdc.gov.nchs

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International Classification of International Classification of Diseases (10Diseases (10thth Revision) Revision) -- ICDICD--1010

•• ICDICD--10 promotes international comparability in 10 promotes international comparability in the collection, classification, processing and the collection, classification, processing and presentation of mortality statistics.presentation of mortality statistics.D l d ll b ti l b t WHO dD l d ll b ti l b t WHO d•• Developed collaboratively between WHO and Developed collaboratively between WHO and 10 international centers10 international centers

•• Effective Oct. 1, 2013 (Now delayed to 10/2015)Effective Oct. 1, 2013 (Now delayed to 10/2015)•• The codeThe code--set will grow from its current 17,000 set will grow from its current 17,000

codes to more than 141,000, and the format is codes to more than 141,000, and the format is new with seven alphanew with seven alpha--numeric codes instead of numeric codes instead of five numeric digits.five numeric digits.

www.cdc.gov.nchswww.cdc.gov.nchs

CPTCPT•• Professional component Professional component

CPT Coding and RVU’sCPT Coding and RVU’s

•• Technical componentTechnical componentRVURVU

•• Relative value unit associated with each Relative value unit associated with each serviceservice

• 2016 Conversion $35.8043 $35.8043

www.cms.govwww.cms.gov

Professional Component (Professional Component (--26)26)

The physicianThe physician

•• Supervises the test Supervises the test

•• Interprets the testInterprets the test

•• Prepares the written reportPrepares the written report

Technical Component (Technical Component (--TC)TC)

Costs associated withCosts associated with

•• The technician’s salary/benefitsThe technician’s salary/benefits

•• The equipmentThe equipment

•• Any necessary suppliesAny necessary supplies

Fully Implemented NonFully Implemented Non--Facility BillingFacility BillingA code reported without a modifierA code reported without a modifier

CombinesCombines

•• Professional componentProfessional componentProfessional componentProfessional component

•• Technical componentTechnical component

•• Any necessary suppliesAny necessary supplies

•• Image storageImage storage

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Physician SupervisionPhysician Supervision

•• General SupervisionGeneral Supervision

•• Direct SupervisionDirect Supervision•• Direct SupervisionDirect Supervision

•• Personal SupervisionPersonal Supervision

Medicare Requirements for Physician Supervision of Sonographers. Medicare Requirements for Physician Supervision of Sonographers. www.acog.org/departmentswww.acog.org/departments

Physician Supervision Physician Supervision General SupervisionGeneral Supervision

•• Procedure is furnished under the Procedure is furnished under the physician’s overall direction and controlphysician’s overall direction and control

•• The physician’s presence isThe physician’s presence is not requirednot requiredThe physician s presence is The physician s presence is not requirednot requiredduring the performance of the procedure.during the performance of the procedure.

•• The training of the nonphysician The training of the nonphysician personnel who perform the diagnostic personnel who perform the diagnostic procedure and equipment maintenance procedure and equipment maintenance are the responsibility of the physicianare the responsibility of the physician


Physician Supervision Physician Supervision Direct SupervisionDirect Supervision

•• The physician must be present in the The physician must be present in the office suite and immediately available office suite and immediately available to furnish assistance and direction to furnish assistance and direction throughout the performance of the throughout the performance of the procedure.procedure.

•• The physician’s inThe physician’s in--room presence is room presence is not requirednot required during the performance during the performance of the procedure.of the procedure.


Physician Supervision Physician Supervision Personal SupervisionPersonal Supervision

•• Physician Physician mustmust be in be in attendance in the room duringattendance in the room duringattendance in the room during attendance in the room during the performance of the the performance of the procedure.procedure.


Physician Supervision Physician Supervision Personal Supervision of Gyn USPersonal Supervision of Gyn US

•• SonohysterographySonohysterography (ultrasound)(ultrasound)SonohysterographySonohysterography (ultrasound)(ultrasound)

•• 76831 76831 -- TCTC

Medicare Requirements for Physician Supervision of Sonographers. Medicare Requirements for Physician Supervision of Sonographers. www.acog.org/departmentswww.acog.org/departmentswww.cms.govwww.cms.gov www.cms.govwww.cms.gov

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Medicare Fee Schedule Medicare Fee Schedule Supervision RequirementsSupervision Requirements

• 0 Procedure is not a diagnostic test or procedure is a diagnostic test that is not subject to the physician supervision policy.j p y p p y

• 1 Procedure must be performed under the general supervision of a physician.

• 2 Procedure must be performed under the direct supervision of a physician.

• 3 Procedure must be performed under the personal supervision of a physician.

• 9 Concept does not apply.

Coding Coding –– Ob SonographyOb Sonography11stst TrimesterTrimester

•• 7680176801 Ultrasound Ultrasound pregnant uterus, real time with pregnant uterus, real time with image documentation, fetal and image documentation, fetal and ggmaternal evaluation, first trimester maternal evaluation, first trimester (< 14 weeks 0 days), (< 14 weeks 0 days), transabdominal approachtransabdominal approach; single ; single or first gestationor first gestation

•• 7680276802 ; each additional ; each additional gestation. Add on code to 76801.gestation. Add on code to 76801.

Coding Coding –– Ob SonographyOb SonographyVaginal SonographyVaginal Sonography

•• 7681776817 Ultrasound pregnant uterus, Ultrasound pregnant uterus, real time with image documentation, real time with image documentation, transvaginaltransvaginal

•• No contingency for multiple gestationsNo contingency for multiple gestations

•• If transvaginal examination is done in If transvaginal examination is done in addition to transabdominal obstetrical addition to transabdominal obstetrical ultrasound exam, use 76817 in addition to ultrasound exam, use 76817 in addition to the appropriate transabdominal codethe appropriate transabdominal code

Coding Coding –– Ob SonographyOb Sonography22ndnd/3/3rdrd TrimesterTrimester

•• 7680576805 Ultrasound pregnant uterus, Ultrasound pregnant uterus, real time with image documentation, real time with image documentation, fetal and maternal evaluation after firstfetal and maternal evaluation after firstfetal and maternal evaluation, after first fetal and maternal evaluation, after first trimester (trimester (>> 14 weeks 0 days), 14 weeks 0 days), transabdominal approach; single or transabdominal approach; single or first gestationfirst gestation

•• 7681076810 ; each additional gestation.; each additional gestation.

•• Add on code to 76805Add on code to 76805

Level 1 ScanLevel 1 Scan

Survey• Viability (cardiac activity)• Fetal number• Fetal number• Fetal presentation• Amniotic fluid volume• Placental positionFetal biometry• BPD, HC, AC, FL, EFW

76805 76805 Standard Content: Basic ScanStandard Content: Basic Scan

Survey• Viability (cardiac activity)• Fetal number• Fetal presentation• Amniotic fluid volume• Placental positionFetal biometry• BPD, HC, AC, FL, EFWAnatomic survey• Head, face and neck, chest, abdomen, spine,

extremities, genderMaternal anatomy• Cervix, adnexa, uterine anomalies

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76805 76805 Essential Elements of AnatomyEssential Elements of Anatomy

Head, face and neck• Cerebellum, choroid plexus, cisterna magna,

lateral ventricles, midline falx, lipsChest• 4-chamber cardiac view• Outflow tracts• Outflow tracts Abdomen• Stomach, kidney, bladder, cord insertion, cord

vessels (adrenal glands)Spine• Cervical, thoracic, lumbar, sacralExtremities• Legs and arms present or absent• (comment on inability to visualize all extremities)

Reddy et al. J Ultrasound Med 2014 May;33(5):745Reddy et al. J Ultrasound Med 2014 May;33(5):745--57. 57. Reddy et al. Am J Obstet Gynecol 2014 May;210(5):387Reddy et al. Am J Obstet Gynecol 2014 May;210(5):387--97. 97. Reddy et al. Obstet Gynecol 2014 May;123(5):1070Reddy et al. Obstet Gynecol 2014 May;123(5):1070--82.82.

Inability to Visualize AnatomyInability to Visualize Anatomy

Obese womenObese women

•• Ultrasound at 20Ultrasound at 20--22 weeks22 weeks

•• 2 weeks later than in the 2 weeks later than in the nonobese patientnonobese patient

Inability to Visualize AnatomyInability to Visualize Anatomy

•• If fetal anatomy cannot be assessed If fetal anatomy cannot be assessed completelycompletely

F llF ll i ti i 2i ti i 2 4 k4 k•• FollowFollow--up examination in 2up examination in 2--4 weeks4 weeks

•• Comment on any limitation of the Comment on any limitation of the examexam

•• FollowFollow--upup

•• Only as clinically indicatedOnly as clinically indicated


•• 7681176811 Ultrasound pregnant uterus, Ultrasound pregnant uterus, real time with image documentation, real time with image documentation, maternal evaluation plus maternal evaluation plus detailed fetal detailed fetal evaluationevaluation, transabdominal approach; , transabdominal approach; single or first gestationsingle or first gestation

•• 76812 76812 ; each additional gestation.; each additional gestation.•• Add on code to 76811Add on code to 76811

Detailed Anatomic ExaminationDetailed Anatomic Examination7681176811

Performed when an anomaly is Performed when an anomaly is t d th b i f hi tt d th b i f hi tsuspected on the basis of history, suspected on the basis of history,

biochemical abnormalities, or the biochemical abnormalities, or the results of either the limited or results of either the limited or standard [basic] scanstandard [basic] scan

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SMFM Statement on 76811SMFM Statement on 76811

Because this code is assigned Because this code is assigned more RVUs than the basic more RVUs than the basic obstetrical sonogram (76805),obstetrical sonogram (76805),obstetrical sonogram (76805), obstetrical sonogram (76805), the SMFM believes the code the SMFM believes the code describes an examination describes an examination involving significantly more work, involving significantly more work, and requiring greater expertise and requiring greater expertise than that required for 76805.than that required for 76805.


Additionally, sophisticated Additionally, sophisticated i t th th t i li t th th t i lequipment, rather than typical equipment, rather than typical

office level ultrasound machines, office level ultrasound machines, will be required to obtain the will be required to obtain the necessary imaging detail.necessary imaging detail.


The level of expertise required to The level of expertise required to perform this examination can generally perform this examination can generally only be obtained through the extendedonly be obtained through the extendedonly be obtained through the extended only be obtained through the extended education beyond residency that is education beyond residency that is acquired in a fellowship in Maternalacquired in a fellowship in Maternal--Fetal Medicine or Radiology…Use of Fetal Medicine or Radiology…Use of this code by general obstetricians this code by general obstetricians should be the exception rather than the should be the exception rather than the rule.rule.

AIUM AIUM –– 7681176811Consensus StatementConsensus Statement

•• Previous fetus or child with a Previous fetus or child with a congenital, genetic, or chromosomalcongenital, genetic, or chromosomalcongenital, genetic, or chromosomal congenital, genetic, or chromosomal abnormalityabnormality

•• Known or suspected fetal anomaly or Known or suspected fetal anomaly or known growth disorder in current known growth disorder in current pregnancypregnancy

76811 Task Force. J Ultrasound Med 2014; 33:18976811 Task Force. J Ultrasound Med 2014; 33:189--195.195.


Fetal at increased risk for a congenital anomaly:Fetal at increased risk for a congenital anomaly:

•• Maternal pregestational diabetes or gestational Maternal pregestational diabetes or gestational diabetes before 24 weeksdiabetes before 24 weeks

•• High BMI (High BMI (>> 35 kg/m35 kg/m22))

•• Multiple gestationMultiple gestation

•• Abnormal maternal serum analytesAbnormal maternal serum analytes

•• Teratogen exposureTeratogen exposure

•• 11stst trimester NT trimester NT >> 3.0 mm3.0 mm



Other conditions affecting the fetus:Other conditions affecting the fetus:

•• Congenital infectionsCongenital infections

•• Maternal drug dependenceMaternal drug dependence

•• IsoimmunizationIsoimmunization

•• OligohydramniosOligohydramnios

•• PolyhydramniosPolyhydramnios


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7681176811

655.8655.8

•• Suspected or known chromosomal Suspected or known chromosomal b litb litabnormalityabnormality

796.5796.5

•• Abnormal finding on antenatal Abnormal finding on antenatal screeningscreening

278.01278.01

•• Severe obesity (BMI Severe obesity (BMI >> 35)35)

Coding Coding –– Ob SonographyOb SonographyLimited studyLimited study

•• 7681576815 Ultrasound pregnant Ultrasound pregnant uterus, real time with image uterus, real time with image documentation limited (e g fetaldocumentation limited (e g fetaldocumentation, limited (e.g., fetal documentation, limited (e.g., fetal heart beat, placental location, fetal heart beat, placental location, fetal position and/or qualitative amniotic position and/or qualitative amniotic fluid volume), one or more fetusesfluid volume), one or more fetuses

•• Use 76815 only once per exam and Use 76815 only once per exam and not per elementnot per element

Coding Coding –– Ob SonographyOb Sonography

7681576815 Limited ExaminationA limited examination is performed whena specific question requires investigation.For example a limited examination couldFor example, a limited examination couldbe performed to confirm fetal heart activityin a bleeding patient or to verify fetal presentationin a laboring patient. In most cases,limited sonographic examinations areappropriate only when a prior completeexamination is on record.

Coding Coding –– Ob SonographyOb Sonography22ndnd/3/3rdrd Trimester, FollowTrimester, Follow--up studyup study

•• 7681676816 Ultrasound pregnant uterus, Ultrasound pregnant uterus, real time with image documentation, real time with image documentation, followfollow--up (e.g., reup (e.g., re--evaluation of fetal size evaluation of fetal size by measuring standard growth parametersby measuring standard growth parametersby measuring standard growth parameters by measuring standard growth parameters and amniotic fluid volume, reand amniotic fluid volume, re--evaluation of evaluation of organ system(s) suspected or confirmed organ system(s) suspected or confirmed to be abnormal on a previous scan), to be abnormal on a previous scan), transabdominal approach, transabdominal approach, per fetusper fetus

•• Report Report 7681676816--5959 for each additional fetus for each additional fetus examined in a multiple pregnancy.examined in a multiple pregnancy.


•• What about the patient who presents What about the patient who presents for a repeat study later in the for a repeat study later in the pregnancy?pregnancy?pregnancy?pregnancy?

•• Code by status of indicationCode by status of indication

•• If new indication, use If new indication, use 7680576805

•• If not new, use If not new, use 7681676816•• Even if complete biometry and Even if complete biometry and

amniotic fluid assessment performedamniotic fluid assessment performed

Coding Coding –– Ob SonographyOb SonographyBiophysical ProfileBiophysical Profile

•• 7681876818 Fetal biophysical profile; Fetal biophysical profile; with nonwith non stress testingstress testingwith nonwith non--stress testingstress testing

•• 7681976819 Fetal biophysical profile; Fetal biophysical profile; without nonwithout non--stress testingstress testing

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Coding Coding –– Ob/Gyn SonographyOb/Gyn SonographyFetal EchocardiographyFetal Echocardiography

•• 7682576825 Fetal initial (2D +/Fetal initial (2D +/-- mm--mode)mode)•• 7682676826 F/U or repeat (2D +/F/U or repeat (2D +/-- mm--mode)mode)

7682776827 D l hD l h i iti li iti l•• 7682776827 Doppler echo Doppler echo -- initialinitial•• 7682876828 Doppler echo Doppler echo –– F/U or repeatF/U or repeat

•• Add to 76825, 26826Add to 76825, 26826•• 93325 93325 Color mappingColor mapping

•• Add to 76825, 76826, 76827, 76828 Add to 76825, 76826, 76827, 76828

Coding Coding –– Ob/Gyn SonographyOb/Gyn SonographyFetal EvaluationFetal Evaluation

•• 7682076820 Umbilical artery DopplerUmbilical artery Doppler

•• 7682176821 Middle cerebral artery Middle cerebral artery DopplerDoppler

Coding Coding –– Ob/Gyn SonographyOb/Gyn Sonography33--D RenderingD Rendering

•• 76376 and 7637776376 and 7637733--D rendering with interpretation D rendering with interpretation and reporting of computedand reporting of computedand reporting of computed and reporting of computed tomography, magnetic resonance tomography, magnetic resonance imaging, ultrasound, or other imaging, ultrasound, or other tomographic modalitytomographic modality

•• Add onAdd on codes to appropriate codes to appropriate ultrasound code(s)ultrasound code(s)

Coding Coding –– Ob/Gyn SonographyOb/Gyn Sonography33--D RenderingD Rendering

•• 7637676376 33--D rendering…D rendering…not requiringnot requiringimage postprocessing on animage postprocessing on animage postprocessing on an image postprocessing on an independent workstation.independent workstation.

•• 7637776377 33--D rendering…D rendering…requiringrequiringimage postprocessing on an image postprocessing on an independent workstation.independent workstation.

Coding in ObCoding in Ob--Gyn SonographyGyn SonographyModifiersModifiers

–– 2222 Unusual complexityUnusual complexity

–– 2626 Professional componentProfessional component

–– 5252 Reduced servicesReduced services5252 Reduced services Reduced services

–– 5959 Distinct procedural service, Distinct procedural service, same day (e.g., referral for same day (e.g., referral for suspected fetal anomaly on suspected fetal anomaly on the same day. the same day.

Ob uses Ob uses 7680576805

Consultant uses Consultant uses 7681176811--5959

Coding Coding –– Ob SonographyOb SonographyNuchal TranslucencyNuchal Translucency

•• 7681376813 Ultrasound pregnant Ultrasound pregnant uterus, real time with image uterus, real time with image documentation first trimester fetaldocumentation first trimester fetaldocumentation, first trimester fetal documentation, first trimester fetal nuchal translucency measurement, nuchal translucency measurement, transabdominal or transvaginal; transabdominal or transvaginal; single or first gestation (List single or first gestation (List separately in addition to code for separately in addition to code for primary procedure)primary procedure)

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Coding Coding –– Ob SonographyOb SonographyNuchal TranslucencyNuchal Translucency

•• 7681476814 Ultrasound pregnant Ultrasound pregnant uterus, real time with image uterus, real time with image documentation first trimester fetaldocumentation first trimester fetaldocumentation, first trimester fetal documentation, first trimester fetal nuchal translucency measurement, nuchal translucency measurement, transabdominal or transvaginal; each transabdominal or transvaginal; each additional gestation (List separately additional gestation (List separately in addition to code for primary in addition to code for primary procedure)procedure)

ICDICD--9 Codes9 Codes•• Use all that applyUse all that apply•• PrioritizePrioritize•• Sparingly use “V codes” (screening codes) as Sparingly use “V codes” (screening codes) as

a primary indicationa primary indicationp yp y•• Note: Advanced maternal age may not be Note: Advanced maternal age may not be

accepted as an indication for ultrasound or accepted as an indication for ultrasound or amnioamnio•• Can use “suspected or known chromosomal Can use “suspected or known chromosomal

abnormality” abnormality” (655.8)(655.8)•• May use diagnosis as reflected on final May use diagnosis as reflected on final

reportreport

Coding Coding -- Gyn UltrasoundGyn Ultrasound

•• Vaginal sonographyVaginal sonography•• DimensionsDimensions•• MorphologyMorphology•• MorphologyMorphology•• Dynamic studiesDynamic studies•• 33--DD

•• Abdominal sonographyAbdominal sonography•• SonohysterographySonohysterography

76830 76830 ––Echography, transvaginalEchography, transvaginal

•• Complete evaluation of the female pelvic Complete evaluation of the female pelvic anatomy anatomy –– vaginal studyvaginal study

•• ElementsElements

•• Description and measurements of uterus Description and measurements of uterus and adnexal structures (cervix)and adnexal structures (cervix)

•• Measurement of the endometriumMeasurement of the endometrium

•• Description of the culDescription of the cul--dede--sac and fluidsac and fluid

•• Description of the bladder (if applicable)Description of the bladder (if applicable)

•• Description of any pelvic pathologyDescription of any pelvic pathology

AdnexaAdnexa

OvariesOvaries

•• DimensionDimension•• LengthLength

•• WidthWidthWidthWidth

•• DepthDepth

•• MorphologyMorphology

•• MotionMotion

•• DopplerDoppler

•• Fallopian TubesFallopian Tubes

•• Usually not visualizedUsually not visualized

76856 76856 –– Gyn Abdominal Gyn Abdominal (add to TVS)(add to TVS)

•• Complete evaluation of the female pelvic Complete evaluation of the female pelvic anatomy anatomy –– abdominal studyabdominal study

•• ElementsElements

•• Description and measurements of Description and measurements of uterus and adnexal structuresuterus and adnexal structures

•• Measurement of the endometriumMeasurement of the endometrium

•• Measurement of the bladder Measurement of the bladder (when applicable)(when applicable)

•• Description of any pelvic pathologyDescription of any pelvic pathology

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76857 76857 –– Gyn Limited or followGyn Limited or follow--upup

•• Ultrasound, pelvic (nonobstetric), Ultrasound, pelvic (nonobstetric), realreal--time with image documentation; time with image documentation; limited or followlimited or follow--up (e.g. for follicles)up (e.g. for follicles)

•• 7685776857•• 7685776857

•• Used if followUsed if follow--up of urinary up of urinary bladder alone, i.e. postbladder alone, i.e. post--void void residual, imagedresidual, imaged

•• 5179851798

•• Used for postUsed for post--void residual nonvoid residual non--imaging: i.e. Bladder scanimaging: i.e. Bladder scan

CPACPA

9397693976

CFDCFD

Coding Gyn SonographyCoding Gyn SonographyDoppler StudiesDoppler Studies

•• 9397593975 Duplex scan of A/V flow: Duplex scan of A/V flow: Abdomen and pelvic Abdomen and pelvic ––CompleteComplete

•• 9397693976 Duplex scan of A/V flow: Duplex scan of A/V flow: Abdomen and pelvic Abdomen and pelvic -- LimitedLimited

Gyn ultrasound Gyn ultrasound –– 3D3D

7637676376

7694276942

7694276942 Ult i idUlt i id•• 7694276942 Ultrasonic guidance Ultrasonic guidance for needle placement imaging for needle placement imaging supervision and interpretation)supervision and interpretation)

76998 76998 –– Intraoperative UltrasoundIntraoperative Ultrasound

•• Ultrasound guidance, Ultrasound guidance, intraoperativeintraoperative

•• 76998769987699876998

•• Ultrasound guided follicular Ultrasound guided follicular aspirationaspiration

•• Ultrasound guided transferUltrasound guided transfer

•• Ultrasound guided Ultrasound guided inseminationinsemination

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76998 76998 –– Intraoperative UltrasoundIntraoperative Ultrasound

Ultrasound guidance, Ultrasound guidance, intraoperativeintraoperative

•• Documentation may be Documentation may be incorporated into the operative incorporated into the operative report. A separate report is not report. A separate report is not requiredrequired

•• Reimbursement for TC = 0.00Reimbursement for TC = 0.00

SonohysterographySonohysterography

•• 7683176831 Hysterosonography; Hysterosonography; with or without color flow Dopplerwith or without color flow Doppler

I l d l t f TVSI l d l t f TVS•• Includes elements of TVS, Includes elements of TVS, therefore is no separate charge therefore is no separate charge for TVSfor TVS

•• 5834058340 Introduction of contrast Introduction of contrast agent or salineagent or saline

SonosalpingographySonosalpingography

•• 7683176831 Saline infusion Saline infusion sonohysterography (SIS), including color sonohysterography (SIS), including color flow Doppler, when performedflow Doppler, when performedflow Doppler, when performedflow Doppler, when performed

•• Includes all elements of 76830 (TVS)Includes all elements of 76830 (TVS)

•• 5834058340 Catheterization and Catheterization and introduction of saline or contrast material introduction of saline or contrast material for saline infusion sonohysterography for saline infusion sonohysterography (SIS) or hysterosalpingography(SIS) or hysterosalpingography

Endometrial CryoablationEndometrial Cryoablation

•• 5835658356 Endometrial cryoablation Endometrial cryoablation with ultrasonic guidancewith ultrasonic guidance, including , including

d t i l tt hd t i l tt hendometrial curettage, when endometrial curettage, when performedperformed

•• Code 58356 cannot be reported with Code 58356 cannot be reported with CPT codes 58100, 58120, 58340, CPT codes 58100, 58120, 58340, 76700, 7685676700, 76856

CPT Coding RulesCPT Coding Rules

•• PrePre--service work can be reported only if service work can be reported only if “significant and separately identifiable ”“significant and separately identifiable ”significant and separately identifiable.significant and separately identifiable.

•• Discussions of procedure & obtaining Discussions of procedure & obtaining informed consent is NOT reported informed consent is NOT reported separatelyseparately


•• PrePre--service work can be reported if: service work can be reported if:

•• Performing another procedure orPerforming another procedure orPerforming another procedure or Performing another procedure or evaluating another problem evaluating another problem

•• Evaluating the patient and decide to Evaluating the patient and decide to perform an ultrasound during the visit perform an ultrasound during the visit

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Coding in OBCoding in OB--Gyn SonographyGyn Sonography

•• Physician interpretation and signed final Physician interpretation and signed final report are components of all codesreport are components of all codes

•• A signed note in the progress notes orA signed note in the progress notes orA signed note in the progress notes or A signed note in the progress notes or patient chart is adequatepatient chart is adequate

•• It is preferable to take photographs and It is preferable to take photographs and place with the note (compliance issues)place with the note (compliance issues)

•• It is preferable to have a formal, final It is preferable to have a formal, final report, retaining all images for the SOLreport, retaining all images for the SOL

CPT General Coding RulesCPT General Coding Rules

•• The diagnosis code should The diagnosis code should demonstrate the medical necessitydemonstrate the medical necessitydemonstrate the medical necessity demonstrate the medical necessity for the procedurefor the procedure

•• Report only the procedures that Report only the procedures that were performed and documentedwere performed and documented


•• Do not change the codes Do not change the codes reported in order to obtain reported in order to obtain reimbursement for nonreimbursement for non coveredcoveredreimbursement for nonreimbursement for non--covered covered services.services.

•• Report the highest valued Report the highest valued procedure code first on the claim procedure code first on the claim form.form.

Thank YouThank YouThank YouThank You

James M. Shwayder, M.D., J.D.James M. Shwayder, M.D., J.D.Professor and ChairProfessor and ChairDepartment of Obstetrics and Gynecology Department of Obstetrics and Gynecology University of MississippiUniversity of MississippiJackson, MississippiJackson, Mississippi

Documents

Outline Coding Resources - IAME · Personal Supervision of Gyn US • Sonohysterography(ultrasound) ... education beyond residency that is acquired in a fellowship in Maternalacquired