Radiology Coding Alert

Don't miss your chance to code 76830 with 76856 when you have documentation of both

If you're still receiving denials for transvaginal ultrasounds on the same date as pelvic ultrasounds, your payer may be shortchanging you, according to the latest National Correct Coding Initiative edits.

NCCI deleted an edit that bundled CPT 76830 (Ultrasound, transvaginal) into 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete). But many coders still report receiving denials for 76830 when they try to report it on the same date as 76856.
 
You shouldn't need to use modifier 59 (Distinct procedural service) to report 76830 separately from 76856, says Collette Shrader with Wenatchee Valley Medical Center in Wenatchee, Wash.

You also shouldn't need a different diagnosis for each code.

The NCCI edit bundling those two codes was probably deleted because of outcry from the specialty societies, Shrader adds. Her facility has been able to report both codes on the same date without a modifier.

Make Your Case for Coverage
 
Non-Medicare payers such as Humana and Aetna have been refusing to pay for both codes on the same date, says Laurie Krachenfels, coding manager with Physician's Service Center in Lombard, Ill. Those payers have denied appeals for those claims, too, she adds.
 
Try this: "Your documentation should fully support both exams," Shrader says. It should show the medical necessity for both scans as well as a physician's order, she says.

The documentation should explain that you performed two studies and include the results of both the pelvic and transvaginal scans, Shrader says. That doesn't mean you need two separate reports, but both sets of findings should be documented separately.

There are often good reasons to perform both scans on the same date, Shrader says. The AMA stated that these two approaches describe distinct studies, and both are often necessary to make accurate diagnoses. Example: Sometimes a pelvic ultrasound won't capture the cervix or other region, and the physician may be able to see some things more clearly on a transvaginal than a pelvic scan, or vice versa.