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Korbc

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Hey,
Does anyone know if you can charge anything for a brief non ob transvag ultrasound without imaging documentation printed out? I had read some opinions you can with a mod 52 but i couldn't find a good authority source on it. If anyone has any good info on this that would be great!. I can't see both sides of yes and no, but i feel like you should be able to charge something since it's not like they aren't doing anything at all......?

thanks!
 
Korbc said:
Hey,
Does anyone know if you can charge anything for a brief non ob transvag ultrasound without imaging documentation printed out? I had read some opinions you can with a mod 52 but i couldn't find a good authority source on it. If anyone has any good info on this that would be great!. I can't see both sides of yes and no, but i feel like you should be able to charge something since it's not like they aren't doing anything at all......?

thanks!
Click to expand...
Per CPT rules, no. The statement is found in the last paragraph of the Diagnostic Ultrasound Guidelines in the CPT book: Us of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.
 
With any coding, the key is the documentation. Performing the work without the documentation cannot be used for coding. Any guidance I have seen regarding documentation for sonograms requires saving of the image(s). It seems there is a fair amount of flexibility about how they may be stored, but they must be permanently stored.
Here are some additional references:
 
nielynco said:
Per CPT rules, no. The statement is found in the last paragraph of the Diagnostic Ultrasound Guidelines in the CPT book: Us of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.
Click to expand...
thanks! i did see that before but just wasn't sure if it was documented in the notes without imaging documentation would be good enough :) thanks so much it seems clear that it's not between you and csperoni :)
thanks!
 
csperoni said:
With any coding, the key is the documentation. Performing the work without the documentation cannot be used for coding. Any guidance I have seen regarding documentation for sonograms requires saving of the image(s). It seems there is a fair amount of flexibility about how they may be stored, but they must be permanently stored.
Here are some additional references:
Click to expand...
 
Hey guys this is to both of you for a limited 76830
say we do document imagining and print out images etc etc and we do a limited 76830 and document the element examined with documented images for an iud check or any reason the would be med necessary and do a lmitied 76830 what should i charge? would it be 76830 with mod 52 or i've even read to charge 76857 because despite it being a different approach 76857 has lower RVU's that might not be the current case as this was an older article in revenue cycle insider. I'm also attaching an image of some parameters i found for 76830 that mentions if evaluation of uterus is not performed or documented to use 52, but what if only 1 of those other sole components are performed and documented findings with also documented imaging could i charge 76380 with 52.

thank you so much
 

Attachments

  • limited transvag 76830.PNG
    limited transvag 76830.PNG
    110 KB · Views: 1
Korbc said:
Hey guys this is to both of you for a limited 76830
say we do document imagining and print out images etc etc and we do a limited 76830 and document the element examined with documented images for an iud check or any reason the would be med necessary and do a lmitied 76830 what should i charge? would it be 76830 with mod 52 or i've even read to charge 76857 because despite it being a different approach 76857 has lower RVU's that might not be the current case as this was an older article in revenue cycle insider. I'm also attaching an image of some parameters i found for 76830 that mentions if evaluation of uterus is not performed or documented to use 52, but what if only 1 of those other sole components are performed and documented findings with also documented imaging could i charge 76380 with 52.

thank you so much
Click to expand...
In reference to the IUD check this is what ACOG has published:

Use of Ultrasound

The performance of an ultrasound to check IUD placement is not bundled into the IUD insertion (code 58300), and it is not common
practice to use ultrasound to confirm placement. Therefore, this should not be routinely billed. However, ultrasonography may be used to confirm the location of the IUD when the qualified clinician incurs a difficult IUD placement (e.g., severe pain, uterine perforation, etc.). If ultrasound is used, one of the following codes is added:

Code 76857 Ultrasound, pelvic [nonobstetric], real time with
image documentation; limited or follow-up, or
Code 76830 Ultrasound, transvaginal

Occasionally, ultrasound is needed to guide IUD insertion. If ultrasound is used, add code 76998 (ultrasonic guidance, intraoperative).

But to answer your question, you would not bill a transabdominal ultrasound if a transvaginal one was performed. As to the use of modifier -52 that will be at the discretion of the payer (who may not recognize this modifier on code 76830) or the provider if the documentation simply indicates the IUD placement and mentions nothing else. The clinical vignette used to add this code to CPT is not very specific as to what is included: intra service info: Supervise the sonographer performing the examination. The ultrasound examination, which may include evaluation of the uterus (including evaluation of the endometrium), ovaries, cul de sac, and parametrium, is interpreted. The examination results are compared and findings are correlated to previous studies. A report is dictated for the medical record.

Note the words "may include".

ACR, on the other hand, is very specific about the evaluation they expect when billing this code. I have always followed ACR on this matter as radiology, after all, is their specialty. I have always recommended using a modifier -52 on 76830 if the only documentation is IUD placement information and not an examination of the any of the uterine structures.
 
nielynco said:
In reference to the IUD check this is what ACOG has published:

Use of Ultrasound

The performance of an ultrasound to check IUD placement is not bundled into the IUD insertion (code 58300), and it is not common
practice to use ultrasound to confirm placement. Therefore, this should not be routinely billed. However, ultrasonography may be used to confirm the location of the IUD when the qualified clinician incurs a difficult IUD placement (e.g., severe pain, uterine perforation, etc.). If ultrasound is used, one of the following codes is added:

Code 76857 Ultrasound, pelvic [nonobstetric], real time with
image documentation; limited or follow-up, or
Code 76830 Ultrasound, transvaginal

Occasionally, ultrasound is needed to guide IUD insertion. If ultrasound is used, add code 76998 (ultrasonic guidance, intraoperative).

But to answer your question, you would not bill a transabdominal ultrasound if a transvaginal one was performed. As to the use of modifier -52 that will be at the discretion of the payer (who may not recognize this modifier on code 76830) or the provider if the documentation simply indicates the IUD placement and mentions nothing else. The clinical vignette used to add this code to CPT is not very specific as to what is included: intra service info: Supervise the sonographer performing the examination. The ultrasound examination, which may include evaluation of the uterus (including evaluation of the endometrium), ovaries, cul de sac, and parametrium, is interpreted. The examination results are compared and findings are correlated to previous studies. A report is dictated for the medical record.

Note the words "may include".

ACR, on the other hand, is very specific about the evaluation they expect when billing this code. I have always followed ACR on this matter as radiology, after all, is their specialty. I have always recommended using a modifier -52 on 76830 if the only documentation is IUD placement information and not an examination of the any of the uterine structures.p
Click to expand...
 
perfect thank you so much! and regarding the 76857 was a scenario that through me off that doesn't even apply to our situation. I was having brain fog it was an older article I'm assuming before code 76817 even existed back in 2002 about what to charge for a limited ob transvag ultrasound. so it didn't even apply since I'm referring to non pregnant people where a quick view is needed for something in particular like an iud check.

Thank you so much for your very thorough info! I attached that older article, it's ancient and really has no relevance anymore
 

Attachments

  • lmited transvag must be before code 76817 was created.PNG
    lmited transvag must be before code 76817 was created.PNG
    149.8 KB · Views: 2
also say of course print outs are done and she does mention view of 1 element besides from just saying iud in correct position etc i would assume then i wouldn't need to put 52 on because of the verbiage you mentioned "may include" :):)

thanks so much!
 
nielynco said:
In reference to the IUD check this is what ACOG has published:

Use of Ultrasound

The performance of an ultrasound to check IUD placement is not bundled into the IUD insertion (code 58300), and it is not common
practice to use ultrasound to confirm placement. Therefore, this should not be routinely billed. However, ultrasonography may be used to confirm the location of the IUD when the qualified clinician incurs a difficult IUD placement (e.g., severe pain, uterine perforation, etc.). If ultrasound is used, one of the following codes is added:

Code 76857 Ultrasound, pelvic [nonobstetric], real time with
image documentation; limited or follow-up, or
Code 76830 Ultrasound, transvaginal

Occasionally, ultrasound is needed to guide IUD insertion. If ultrasound is used, add code 76998 (ultrasonic guidance, intraoperative).

But to answer your question, you would not bill a transabdominal ultrasound if a transvaginal one was performed. As to the use of modifier -52 that will be at the discretion of the payer (who may not recognize this modifier on code 76830) or the provider if the documentation simply indicates the IUD placement and mentions nothing else. The clinical vignette used to add this code to CPT is not very specific as to what is included: intra service info: Supervise the sonographer performing the examination. The ultrasound examination, which may include evaluation of the uterus (including evaluation of the endometrium), ovaries, cul de sac, and parametrium, is interpreted. The examination results are compared and findings are correlated to previous studies. A report is dictated for the medical record.

Note the words "may include".

ACR, on the other hand, is very specific about the evaluation they expect when billing this code. I have always followed ACR on this matter as radiology, after all, is their specialty. I have always recommended using a modifier -52 on 76830 if the only documentation is IUD placement information and not an examination of the any of the uterine structures.
Click to expand...
Hey Melanie!
Just also wondering how current is the clinical vignette. Since the excerpt from ACR that I've attached doesn't use the verbiage "may include" and seems like in the information I attached they want 52 used if not all the elements are viewed. I want to go with the most recent information :)
 

Attachments

  • limited transvag 76830.PNG
    limited transvag 76830.PNG
    110 KB · Views: 2
Korbc said:
Hey Melanie!
Just also wondering how current is the clinical vignette. Since the excerpt from ACR that I've attached doesn't use the verbiage "may include" and seems like in the information I attached they want 52 used if not all the elements are viewed. I want to go with the most recent information :)
Click to expand...
Up to you. CPT does not update their vignettes once the service is granted a code unless they modify the code, and the RVUs assigned to the code are based on the work described in the vignette.
 
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