I am a nurse and a new coder. I work for an insurance company & we received a claim for the following services: DEXA (77080), x ray of the Pelvis (72170),US of the Abdo Back(76775), Pelvic US (76856), TV US (76830) & a vascular study(93976). The MD's requisition was only for a pelvic US for postmenopausal bldg, and I don't think the report we received supports all the codes billed. I have a separate DEXA report which doesn't mention any pelvic or spine x rays, and then this report :

Pelvic Ultrasound:
Indication: Post menopausal bleeding

Transabdominal and transvaginal US show the uterus to be moderately enlarged. Centrally within the uterus there is a large, slightly more hypoechoic heterogenous density measuring up to 4.2 cm in diameter. The endometrium is not separately identified from this and this may represent an endometrial tumor versus a lrge submucosal fibroid. Color doppler did not show increased flow withn the mass. Separate from this in a subserosal location anteriorly in the mid uterime segment on the left there is a 1.6cm focal hypoechoic area compatible with a small subserosal fibroid.

The ovaries appear normal and small bilaterally. There is no free fluid in the pelvis. Several small nabothian cysts in the cervix are noted measuring a few mm in diameter. Doppler shows normal blood flow to both adnexal regions with normal arterial resistive indexes.

Screening of the kidneys showed a normal appearance without evidence of hydronephrosis.

Can anyone please tell me if this documentation supports the billing of all the codes listed above? I'm particularly uncertain about the vascular study. I also don't think the x rays of the spine and pelvis, or the US of the Abdo Back are billable based on the documentation.

Sorry this is so long, but i thought you'd need all of this!

Thanks for any insight - it's very much appreciated!