Radiology Coding Alert

Question: On occasion, our radiologists perform both a pelvic and a transvaginal ultrasound on the same day. We code and bill both, but often get paid for only one of the studies. Are we correct in reporting both? If so, why dont we get paid?

New Hampshire Subscriber

Answer: Yes, you may bill for both studies on the same day. As youve discovered, however, you may be paid for only one, depending on the carriers policies.

The American Medical Association has stated that the two approaches describe distinct studies and that the services performed for the transvaginal echography (76830, echography, transvaginal) are not included as part of the pelvic ultrasound examination (i.e., 76856, echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete). It notes that both are necessary to making accurate diagnoses in many instances. Because both of the approaches view some of the same organs; however, payers sometimes argue that both should not be performed on the same day on the same patient.

Ultrasound technologists counter that, while both types may view the same organs, the transvaginal approach allows a more precise field for examination, allowing the technologist to visualize more detailed anatomy.

For example, a patient may be referred for an ultrasound because of excessive menstrual bleeding (626.2). A standard transabdominal pelvic ultrasound is performed and the technician identifies a small uterine mass that may be contributing to the womans condition. However, he or she is unable to get a clear view because of the location of the mass. He or she then use a transvaginal approach to get a more precise image of the abnormality. Under these circumstances, the study would be coded 76856 and 76830-51. Modifier -51 (multiple procedures) is added to describe the transvaginal ultrasound as the secondary, additional service.


Answers for Reader Questions were provided by Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispecialty group practice in Buckhannon, W.Va., and Lisa Grimes, RT (R), radiology special procedures technologist and reimbursement specialist for the University of Texas/Houston Health Sciences Center.