Ob-Gyn Coding Alert

Question: How can I code a transvaginal ultrasound of the ovaries to follow follicles in a gonadotropin stimulated cycle? Generally, I perform one ultrasound when I see the patient initially and code 76856, then code 76857 for the follow-up transvaginal scans used to measure follicles. The corresponding diagnosis is usually an infertility code like 628.9 (infertility, female, of unspecified origin).

Maryland Subscriber

Answer: There are two options for billing an initial ultrasound: 76830 (echography, transvaginal) or 76856 (echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete). The only difference between the two is that the procedure described by 76830 uses a vaginal transducer, while 76856 is performed with an abdominal transducer. According to the American College of Obstetricians and Gynocologists Ob/Gyn Coding Manual: Components of Correct Procedural Coding, the imaging for both procedures involves a study of the uterus, tubes, ovaries and pelvic structures, as indicated. Therefore the approach should determine which code to use.

Note: The Medicare fee schedule assigns the same number of RVUs for both 76830 and 76856 (2.62 RVUs in 2000 and 2.61 RVUs in 2001), so there is no financial advantage to using one code over the other.

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]) clearly describes the procedure performed and may be reported. In this case there is no need to differentiate between a transvaginal and abdominal approach.