Ob-Gyn Coding Alert

Reader Questions:

Draw the Line Between Hysterosalpingogram/Hysterosonogram

Question: What is the difference between a hysterosalpingogram and a hysterosonogram? Which is called an HSG? What I am looking for is the procedure an ob-gyn would do three months post-Essure placement. Radiology is telling me that they report 58340, 76831, 76830, 76856, and 74740. This seems like a lot of codes for one procedure. What should I code for a post-Essure HSG testing?

Georgia Subscriber

Answer: You’re right. These are way too many codes.

Here’s what you need to know: Your coding all comes down to what the physician ordered as the test. If the test’s purpose is to be certain the patient’s tubes are occluded, you should look at a hysterosalpingogram (HSG), not a hysterosonogram (SIS).

Code 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography) represents the ob-gyn injecting saline into the uterus (SIS or hysterosonogram) or injecting contrast dye (HSG or hysterosalpingogram).

HSG: When the ob-gyn performs an HSG, the corresponding radiology code is 74740 (Hysterosalpingography, radiological supervision and interpretation) along with 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography), not 76831.

Unless your physician also ordered a complete pelvic ultrasound that he then had to complete transvaginally, the HSG codes are all that should be billed at this three-month check.

SIS: When the ob-gyn injects saline only, he is performing only an ultrasound, and you should bill 76831 (Saline infusion sonohysterography [SIS], including color flow Doppler, when performed). You could report 76830 (Ultrasound, transvaginal) with modifier 59 (Distinct procedural service) if the ob-gyn performed and documented this service separately from the SIS.

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