Radiology Coding Alert

Turn to codes 74740 and 74742 for S&I done by your radiologist.

Hysterosalpingography (HSG) coding, though easy, may leave you perplexed if you do not understand what your radiologist actually does during the procedure. For instance, your radiologist may be actually performing the procedure, only supervising the procedure, or may be interpreting the results of the procedure. In any case, you have definitive codes that you can bank upon. Also remember that HSG is different from sonohysterography. Here is how you can best report these procedures. 

What is HSG? HSG is an imaging test that your physician does to evaluate the fallopian tubes and the uterine cavity. Your physician places a catheter into the cervix, into the uterus, and through the fallopian tube. Your physician may also use a guide and wire system through the catheter to clear any blockages in the fallopian tube and facilitate a recanalization. This is a procedure you will commonly see being performed in patients with infertility due to a tubal block.

76831 is inclusive of Doppler study

To report sonohysterography, you can best choose to report code 76831 (Saline infusion sonohysterography [SIS], including color flow Doppler, when performed).

What is sonohysterography? When you read that your physician did a sonohysterography, you should interpret that your physician did an ultrasound evaluation of the uterine cavity. Your physician may use saline as a contrast or distending medium during the ultrasound evaluation. Hence this procedure is called saline infusion sonohysterography (SIS).

The procedure note may read as follows:

“With the patient in dorsal lithotomy position, a pelvic examination was done to confirm the size, shape, and position of the uterus. A vaginal speculum was then used to visualize and gain clear access to the cervix.

The syringe and catheter were then filled up with warm saline. The catheter was gradually advanced through the cervical os into the uterine cavity. After the infusion catheter was in place, the vaginal speculum was gently withdrawn. Ultrasound examination was done using an ultrasound probe through the transvaginal route. Around 10-30 ml of warmed saline was then injected and the full uterine cavity was surveyed using the ultrasound probe.”

Note: Your physician may also do a Doppler study to evaluate the flow of blood in the vessels. Remember that a Doppler when done is inclusive in 76831. 

Do not report the ultrasound: In the example described above, you see the physician is doing the SIS and vaginal ultrasound. However, you cannot be reporting 76831 and 76830 (Ultrasound, transvaginal). Remember, code 76831 includes the services in code 76830. Under normal circumstances, it is not acceptable that you report both codes during the same patient encounter.

Determine Services for 58340 vs 74740

When your radiologist does a HSG, you need to confirm the extent of services to be able to report the correct code. You need to check for two possible scenarios. Check if your radiologist only did the imaging or actually performed the entire procedure. 

Scenario 1: When your radiologist only did the imaging, i.e. supervision and interpretation, you typically select code 74740 (Hysterosalpingography, radiological supervision and interpretation).

Scenario 2: When your radiologist actually does the catheterization and introduces saline, you report code 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography).

Both services: Your radiologist may even perform both services. In this case, you may report both codes 74740 and 58340.

Be specific for supervision: Your radiologist must be present during the procedure if you bill for supervision. However, if your radiologist is not in the room for the procedure and only performs the interpretation, you should report 74740 and append modifier 52 (Reduced services). 

Check for facility setting: If your physician does the procedure in a hospital or facility setting, you also append modifier 26 (Professional component) to 74740. Note that you should not append modifier 26 to 58340 because, as a procedural service, it is not divided into professional and technical components.

HSG Is Not Mandate For 58345

Consider code 58345 (Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency [any method], with or without hysterosalpingography) when your physician uses HSG to establish tubal patency. 

Example: In a patient with suspected recurrence of endometriosis causing a fallopian tube occlusion, your physician did HSG. Your physician may document that the HSG revealed regular tubal pressures, but incomplete dye spillage on both tubes. In such a case, your physician may decide to go in for catheterizations. You report these procedures with code 58345 and append modifier 50 (Bilateral procedure) to indicate that the procedure was done on both the right and left sides.

Diagnosis coding: Your physician is doing the HSG to test for tubal patency. This may be because the patient may have reported with fertility issues. Since your physician is doing a diagnostic procedure, you should go with V26.21 (Fertility testing). You would not use a 628.2 code (Infertility female of tubal origin) unless you have confirmed that the patient is infertile.

ICD-10: When your diagnosis system changes to ICD-10, you will report Z31.41 (Encounter for fertility testing) instead of V26.21.

Turn to 74742 for S&I: When your physician only provides radiological supervision and interpretation for the transcervical catheterization, you report code 74742 (Transcervical catheterization of fallopian tube, radiological supervision and interpretation) instead of 58345.