Ob-Gyn Coding Alert

Don't report a nonobstetric transvaginal ultrasound with a complete pelvic ultrasound because the National Correct Coding Initiative (NCCI) now bundles them.
 
NCCI version 9.3, effective Oct. 1 until year-end, bundles 76830 (Ultrasound, transvaginal) into 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) because it is considered standard medical practice. You should report only the abdominal approach in most cases. The new edits also include 76830 in 76857 (... limited or follow-up [e.g., for follicles]) because the limited ultrasound is the more extensive procedure.
 
Medicare has indicated that you can bypass these edits with modifier -59 (Distinct procedural service). For example, the ob-gyn would have to perform transvaginal ultrasound for a different reason, such as viewing a different anatomic structure like a cervix. If the physician uses both the transvaginal and complete or limited ultrasound to view the same structures at different angles, you would not meet the definition of modifier -59 - that is, different session, different patient encounter, different incision or excision, different organ or site, separate lesion, or separate injury.
 
NCCI 9.3 also bundles the following three codes with a "0" indicator, meaning you cannot bypass the edit, into the observation codes (99217-99220) and the emergency department codes (99281-99285):

   90862 - Pharmacologic management, including  prescription, use, and review of medication with no  more than minimal medical psychotherapy
   94660 - Continuous positive airway pressure ventilation (CPAP), initiation and management
   94662 - Continuous negative pressure ventilation (CNP), initiation and management.  Generally, however, ob-gyns would not use codes 94660 and 94662.