Ob-Gyn Coding Alert

Answer: There is no reason why your CNM and the radiologist cannot bill both ultrasound services. In some cases, the Correct Coding Initiative disallows specific codes reported on the same day. These apply to mutually exclusive procedures, which are those that cannot be performed during the same operative session, and comprehensive and component procedures, which are not reimbursed when the practitioner provides the component procedure on the same date as the comprehensive service.

Transvaginal (76830, Ultrasound, transvaginal) and limited transabdominal ultrasounds (76815, Ultrasound, pregnant uterus, B-scan and/or real time with image documentation; limited [fetal size, heart beat, placental location, fetal position, or emergency in the delivery room]) do not fall into either category, however, and both may be coded and billed. Some insurers may require that you append modifier -59 (Distinct procedural service) to the transvaginal code to indicate that the service is not a component of another procedure. But this may not help you if the payer's written policy stipulates that only one diagnostic service is payable per patient per day (regardless of the healthcare provider's opinion). If this is the case, you may want to consider having the limited ultrasound done the next day, assuming a one-day delay will not harm the patient.