Radiology Coding Alert

Follow these tips to prove medical necessityWatch out: You could be one of the radiology practices losing out on reimbursement for Doppler exams performed with ultrasound.To get a closer look at what will -- and won't -- fly when you have to back up your claims, evaluate the real-life order and report below. Then see what our experts Raymond E. Bertino, MD, FACR, FSRU, vascular and general ultrasound director for OSF Saint Francis Medical Center, radiology and surgery clinical professor at University of Illinois College of Medicine at Peoria, and Jackie Miller, RHIA, CPC, radiology coding expert and senior coding consultant for Coding Strategies, Inc., in Powder Springs, Ga., have to say about which codes you should and shouldn't assign on your claim.Match Order and Report for This US CaseOrder: Transvaginal pelvic ultrasound, check endometriosisReport: Pelvic UltrasoundClinical: History of endometrial biopsyTransabdominal as well as transvaginal including color Doppler evaluation of the pelvis was performed. The uterus is normal in size. The uterus is midline and anteverted and measures 8.8 x 3.2 x 5.6 cm. There is no intramural, endometrial or subserosal mass. The endometrial stripe is within the upper limits of normal measuring 6 mm. The cervix and vagina appear normal.The uterus does contain multiple small fibroids. The largest fibroid measures 9 x 8 mm and involves the posterior body.The left ovary is enlarged. The left ovary measures 3.5 x 2.5 x 2.3 cm. The left ovary is enlarged secondary to a complex left ovarian cyst measuring 2.7 x 2.2 cm. This is predominantly cystic but does have a nodular density within its base. The nodular density measures 1.1 x 1.5 cm. Doppler evaluation demonstrates a resistive index of 0.3 suggestive of low resistive blood flow.The right ovary is normal measuring 2.2 x 1.1 x 1.0 cm.There is no pelvic adenopathy or ascites.Impression:1. Enlarged left ovary secondary to a complex left ovarian cyst measuring 3.5 x 2.5 x 2.3 cm. This has a solid nodular density within it. Doppler evaluation demonstrates low resistive flow. Correlation with CEA as well as CA-125 levels is suggested. A follow-up study in 4-6 weeks is suggested to verify stability or resolution of this complex cyst.2. Fibroid uterus as discussed above.3. The endometrial stripe is within the upper limits of normal at 6 mm.Note the Cost of Poor US/Doppler DocumentationAlthough the sample order indicates only a transvaginal ultrasound, the report suggests at least three procedures, notes Bertino:1. transvaginal ultrasound (TV US)2. transabdominal ultrasound (TA US)3. Doppler evaluation.Reporting the TV US alone is the safest bet for the sample report, says Miller.The cost: Medicare lists 3.08 transition facility total relative value units (RVUs) for 76830 (Ultrasound, transvaginal). Code 76856 (Ultrasound, pelvic [nonobstetric], real time with image [...]