Ob-Gyn Coding Alert

Question: How should I code a transvaginal ultrasound of the ovaries to follow follicles in a gonadotropin-stimulated cycle? I usually do one ultrasound when I initially see the patient and code it as 76856, and then code the follow-up transvaginal scans just to measure follicles as 76857. The ICD-9 code is usually an infertility code like 628.9 (infertility, female, of unspecified origin).

Gregg McAdoo
Minot, Md.

Answer: There are basically two options for billing the initial ultrasound. Code 76830 (echography, transvaginal) or 76856 (echography, pelvis [non-obstetric], B-scan and/or real time with image documentation; complete). The only difference is that 76830 uses a vaginal transducer, and 76856 represents the procedure performed with an abdominal transducer. The imaging for both of these codes, according to the ACOG coding manual (Ob/Gyn Coding Manual: Components of Correct Procedural Coding, pages 305 and 307), involves looking at the uterus, tubes, ovaries and pelvic structures, as indicated. Let the approach determine which code to use.

For the follow-up to check for follicles, 76857 (echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles]) may be reported because it clearly describes the procedure performed. In this case, it will not matter whether the procedure is done transvaginally or abdominally. The Medicare fee schedule assigns the same number of relative value units (RVUs) for both 76830 and 76856 (2.62 RVUs), so there is no advantage to using one code over the other.