Ob-Gyn Coding Alert

Question: We have been using 58340 and 76831 to report sonohysterogram/saline infusion ultrasounds. Are these codes correct?

Alaska Subscriber

Answer: Both 58340 (catheterization and introduction of saline or contrast material for hysterosonography or hysterosalpingography) and 76831 (hysterosonography, with or without color flow Doppler) should be used when the same provider performs both procedures.
 
When coding these procedures, remember that:
 
1. Although physicians report 58340 whenever saline is injected into the uterus before an ultrasound, Medicare assigns relative value units (RVUs) to the procedure based on place of service. If the procedure is performed in the office, it is valued at 13.38 RVUs; if it is performed in the hospital or other outpatient setting, it is valued at 1.29 RVUs.
 
The same could be said for the ultrasound. If it is performed in the office, 76831 is reported (22.53 RVUs); if hospital or radiology department equipment is used, you can only bill for the professional component of the ultrasound using 76831 with modifier -26 (professional component) appended (1.01 RVUs).
 
2. Code 58340 is listed first regardless of place of service because it is the highest-valued procedure. If you do not do this, the payer may choose to pay the ultrasound only.
 
3. If the service is not performed in the office, the ultrasound procedure may pay lower than expected.
 
4. The payer might expect to see modifier -51 (multiple procedures) appended to the ultrasound code.