Ob-Gyn Coding Alert

Question: I’m stumped with whether to add the 74742 to HSGs that are done when our physicians do them. Below is a typical note in the op report regarding the procedure:

The speculum was placed and the cervix was grasped with an Allis tenaculum. Endocervical followed by endometrial cultures were taken. Vaginal prep with Betadine was performed. IV Ancef was then administered by anesthesia for surgical antibiotic prophylaxis. The cervix was serially dilated up to 15mm. The c-arm fluoroscopy unit was put into place and the selective hysterosalpingogram catheter was placed into the uterus. The uterus was noted to be normal in contour. The left tube was isolated and the pressure was noted to be <2 atm. The right tube was then isolated and the pressure was noted to be 4atm. Decision was made to perform transcervical endosalpingolysis on the patient’s right fallopian tube. Under fluoroscopy, the right fallopian tube was opened in three successive passes using a 3F Cook catheter with its 0.018 in flexible tipped stainless steel metal guidewire. The right tube was isolated again and the pressure was noted to be <2 atm with dye flowing easily down the fallopian tube. The catheter and c-arm unit were then removed.

Would this be sufficient enough to bill 58345 and 74742?

Kansas Subscriber

Answer: Yes, you are correct. You should report 58345 (Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency [any method], with or without hysterosalpingography) and 74742 (Transcervical catheterization of fallopian tube, radiological supervision and interpretation).

As the use of a fluoroscope usually implies the procedure was performed in a facility, code 74742 would require a modifier 26 (Professional component) as the facility will be billing for the Technical Component (TC).