Ob-Gyn Coding Alert

Question: Our office performs sonohysterograms and we are coding as follows: 76831 Hysterosonography, with or without color flow Doppler; 58340 Catheterization and introduction of saline or contrast material for hysterosonography or hysterosalpingography; A4560 Supply tray.

Please advise if this is the correct way of billing this procedure. Are modifiers needed here? Is there a CPT code for the imaging supervision and interpretation when performed by a physician?

Barbara Jean White, CMM CMPE, Administrator
Tidewater Physicians for Women, Norfolk, VA

Answer: Your excellent question explores an area of increasing confusion. There are no modifiers required on either the code 76831 or 58340, because the sonohysterogram was performed in your office. No modifier is required for the physician who is both performing the ultrasound (technical component) and providing the official written interpretation. This includes times when an office technician actually performs the scan under the supervision of the physician. But this only applies so long as the technical component is not being billed by another entity not associated with the physicians office (such as a outpatient hospital radiology department, or freestanding radiology service).

When another entity provides the technical component, the physician who provides the interpretation only (and the only one who provides the official written report) would bill the ultrasound code with a modifier -26 (professional component) added. The usual rule of a modifier -51 for multiple procedures does not apply here because you are performing distinct services (i.e. one surgical and one ultrasound). Concerning the code A4560 (a Medicare code for surgical supply), Medicare will not reimburse for a surgical tray with either of these procedures because the cost of supplies has been accounted for in the practice expense relative value unit for the surgical code and the ultrasound code. Some private payers also do not cover the supplies separately from reimbursement for the procedure, and any payer who cannot process an alphanumeric code would have problem with A4560. The code 99070 is the CPT code for supplies that are over and above those normally required to perform the procedure. This code would be reserved for supplies that must be ordered for a specific patient, not supplies that are always required for the procedure.