Wiki Why a 52 modifier on a 76817?

[Jesskatcurry]

Hello! I work for an OBGYN as a newer coder and recently a coworker told us that we need to add a 52 modifier on any 76817 that didn't have the cervical length measured. We all started doing it but after doing some research I'm a bit confused as to why. I completely understand the 52 modifier and use it for other circumstances for reduced services. However, I can't find out solid proof as to what anatomical sites need to be documented for a TVU to be considered complete vs "limited" and needing the 52.

I know ACOG's guidelines state that a 76817 may include:
- Evaluation of the embryo and gestational sac(s)
- Evaluation of the maternal uterus, adnexa, and/or cervix.

I know that ACOG also says 76817 is the universal screening for cervical length but is it necessary? Is there any proof I can provide as to why or why not the modifer is necessary without a cervical length? I just want to code as clean as possible.

Thank you so much in advance!

 

[nielynco]

Hello! I work for an OBGYN as a newer coder and recently a coworker told us that we need to add a 52 modifier on any 76817 that didn't have the cervical length measured. We all started doing it but after doing some research I'm a bit confused as to why. I completely understand the 52 modifier and use it for other circumstances for reduced services. However, I can't find out solid proof as to what anatomical sites need to be documented for a TVU to be considered complete vs "limited" and needing the 52.

I know ACOG's guidelines state that a 76817 may include:
- Evaluation of the embryo and gestational sac(s)
- Evaluation of the maternal uterus, adnexa, and/or cervix.

I know that ACOG also says 76817 is the universal screening for cervical length but is it necessary? Is there any proof I can provide as to why or why not the modifer is necessary without a cervical length? I just want to code as clean as possible.

Thank you so much in advance!

Per the ACR when they added this code to CPT back in 2003 "Typically 76817 is used in the first trimester but may also be used later in a pregnancy to evaluate cervical length and the position of the placenta relative to the internal cervical os. Radiologists should use 76817 in addition to the appropriate transabdominal code if both transabdominal and transvaginal studies are performed" In addition, the following vignette was submitted to CPT to explain the use of this code:

"A 31-year-old female in her second pregnancy presents. Her first pregnancy was complicated by preterm rupture of the membranes at 28 weeks gestation. A fetal scan for anatomy was performed at 18 weeks and was normal. She is seen at 22 weeks of pregnancy for transvaginal ultrasound determination of cervical length and determination of the presence of cervical funneling.

Clinical information and pertinent prior imaging studies are reviewed. The patient is informed of the transvaginal technique

The sonographer performing the examination is supervised. Interpretation of the examination includes the following elements: evaluation of the fetus and placenta, evaluation of the maternal uterus and adnexa, and evaluation of characteristics of cervix including length and structure. A report for the medical record is prepared.

Findings are discussed with the patient and referring physician when appropriate. The prepared report is reviewed and signed."

While cervical length is certainly one reason for performing the TVU, it may not be the only reason. The modifier -52 is not required as long as the elements described in the vignette are documented. And it appears that there is an expectation that the interpretation by the physician would include comments with regard to the fetus, placenta, uterus and adnexa (if visible), and the cervix. Using this vignette as the basis for the work required, if they ONLY document cervical length, that would be a reason to apply the modifier -52.

 

[Jesskatcurry]

Per the ACR when they added this code to CPT back in 2003 "Typically 76817 is used in the first trimester but may also be used later in a pregnancy to evaluate cervical length and the position of the placenta relative to the internal cervical os. Radiologists should use 76817 in addition to the appropriate transabdominal code if both transabdominal and transvaginal studies are performed" In addition, the following vignette was submitted to CPT to explain the use of this code:

"A 31-year-old female in her second pregnancy presents. Her first pregnancy was complicated by preterm rupture of the membranes at 28 weeks gestation. A fetal scan for anatomy was performed at 18 weeks and was normal. She is seen at 22 weeks of pregnancy for transvaginal ultrasound determination of cervical length and determination of the presence of cervical funneling.

Clinical information and pertinent prior imaging studies are reviewed. The patient is informed of the transvaginal technique

The sonographer performing the examination is supervised. Interpretation of the examination includes the following elements: evaluation of the fetus and placenta, evaluation of the maternal uterus and adnexa, and evaluation of characteristics of cervix including length and structure. A report for the medical record is prepared.

Findings are discussed with the patient and referring physician when appropriate. The prepared report is reviewed and signed."

While cervical length is certainly one reason for performing the TVU, it may not be the only reason. The modifier -52 is not required as long as the elements described in the vignette are documented. And it appears that there is an expectation that the interpretation by the physician would include comments with regard to the fetus, placenta, uterus and adnexa (if visible), and the cervix. Using this vignette as the basis for the work required, if they ONLY document cervical length, that would be a reason to apply the modifier -52.

Thank you so much! This is immensely helpful! You are wonderful!