Cigna ultrasounds in office 76830

[klapetri@ilovemygyn.com]

OB/GYN-New York.

Cigna recently started to deny cpt code 76830 stating it's considered experimental/investigational/unproven

has anyone else received similar denial?

 

[SharonCollachi]

It sounds like a diagnosis problem, as it may be unproven for the diagnosis.

 

[klapetri@ilovemygyn.com]

dx code is valid, it is not on list of not applicable codes per Cigna policy

 

[csperoni]

I have not seen any denials, and we do a lot of ultrasounds in our practice. I too would suggest checking the diagnosis.

 

[klapetri@ilovemygyn.com]

I appreciate the feedback.

I contacted Cigna provider relations representative, she advised new policy effective 1/15/2020.
I asked if we should refer patients out for ultrasounds. She advised "if claims getting denied you probably should"

Response is still not clear to me...

When we called on claim denial, claims rep. advised to refer to policy, it's considered "Considered Experimental/Investigational/Unproven:"

Has any else reviewed Cigna's policy?

Transvaginal Ultrasound, Non-Obstetrical
Effective Date............................................. 1/15/2020
Next Review Date....................................... 1/15/2021
Coverage Policy Number.................................. 0398


Greatly appreciate the help!

 

[csperoni]

Here is the link to the policy https://cignaforhcp.cigna.com/publi...epositioncriteria_transvaginal_ultrasound.pdf
It is related to the diagnosis. The policy specifies what diagnoses are considered experimental/investigational. Basically, you can't perform the sonogram as a screening tool in asymptomatic average risk women. There needs to be a medical reason to perform the sonogram.

 

[klapetri@ilovemygyn.com]

Understood, but this is what we're billing.

Please see below.

I appreciate the help!

CPT-76830

Diagnosis used
dysmenorrhea N94.6
ovarian cyst-right side N83.291
excessive and frequent menstruation with regular cycle N92.0
Excessive and frequent menstruation with irregular cycle N92.1
Subserosal leiomyoma of uterus D25.2
Polycystic ovarian syndrome E28.2
Right lower quadrant pain R10.31
Pelvic and perineal pain R10.2
Submucous leiomyoma of uterus D25.0

 

[SharonCollachi]

Which four of these did you put on the ultrasound?

According to the policy, this is the ONLY covered reason: Non-obstetrical transvaginal ultrasound is considered medically necessary for the evaluation of suspected pelvic pathology or for screening or surveillance of a woman at increased risk for ovarian or endometrial cancer.