Ob-Gyn Coding Alert

Question: How should I code a transvaginal ultrasound of the ovaries to measure follicles in a gonadotropin-stimulated cycle? I do one ultrasound when I initially see the patient and code it as 76856 and then code the follow-up transvaginal scans as 76857. The ICD-9 code is usually an infertility code such as 628.9.

Minnesota Subscriber

Answer: You can use 76830 (echography, transvaginal) or 76856 (echography, pelvic [non-obstetric], B-scan and/or real time with image documentation; complete) to bill the initial ultrasound. The only difference between these two codes is that 76830 uses a vaginal transducer and 76856 uses an abdominal transducer. Imaging for both codes, according to the ACOG Coding Manual (Ob/Gyn Coding Manual: Components of Correct Procedural Coding, pp. 305-307), involves looking at the "uterus, tubes, ovaries and pelvic structures, as indicated." The approach determines which code to use.
 
For the follow-up to check for follicles, use 76857 (echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles]), because it describes the procedure clearly. It does not matter whether the procedure is done transvaginally or abdominally. Medicare's fee schedule assigns the same number of RVUs for both 76830 and 76856 (2.62 RVUs), and there is no advantage to using one code over the other.