(2023) CPT Code 76830 | Description, Reimbursement & Examples

CPT code 76830, a medical procedure code for Diagnostic Ultrasound Procedures of the Pelvis Non-Obstetrical, is still used by the American Medical Association. 

Description

The uterus, fallopian tubes, ovaries, cervix, and vagina are examined by Transvaginal ultrasonography in female patients. It is not uncommon to see codes for the pelvic region in radiology, including ovarian cysts, pelvic pain, and stomach pain.

The official description of CPT code 76830 is: “Ultrasound, transvaginal.”

CPT code 76830 is the most widely used ultrasound code for the pelvis. It is the most often used CPT code when it comes to ultrasonography. Only the CPT codes for pelvic code (76856) and endovaginal codes should be used by medical coders without reading the material first (CPT code 76830). 

The CPT codes for this procedure are 76856 and 76857, which relate to Pelvic Ultrasound. The uterus, adnexal structures, ovaries, endometrium, bladder, and pelvic diagnostic are now all included in CPT code 76856.

CPT code 76857 must be used when only one organ or region of the pelvis is examined.

 In the medical payment procedure for the case of CPT 76830, there is no need to mix the OB with Non-OB Codes for pelvic exams. The CPT codes for pelvic ultrasonic OB exams begin with 76801 and 76810.

These three CPT codes are 76856, 76587, and 76830 in the non-OB CPT Pelvic CPT codes.

Transvaginal ultrasounds are coded differently depending on whether the patient is pregnant and whether one or many fetuses/babies are present. Hence there is no one-code answer for this CPT code.

 There are three CPT codes for obstetrical trans-vaginal ultrasounds: 76813, 76814, and 76817. A non-obstetrical ultrasound code (76830) should be used if there is no pregnancy. Television ultrasound (TVU CL) is a safe and accurate screening method that may be widely used. 

All sides in the debate over universal cervical length (CL) screening for preterm birth have legitimate reasons. Singleton pregnancies with or without a history of premature birth can benefit from cervical length screening.

 Because of this, some doctors may feel that routine second-trimester TVU is a viable screening approach. Third-party payers should not deny reimbursement for this screening. 

CPT code 76830 is used for a non-obstetrical transvaginal ultrasound. First trimester (14 weeks 0 days), trans-abdominal approach (single or first gestation), ultrasound, and real-time photo documentation are all included in CPT code 76801. 

76830 CPT code encourages a physician to utilize the appropriate trans-abdominal exam code in conjunction with the non-obstetrical transvaginal exam code (76830) in cases where both are performed. 

Regarding CPT® codes, transvaginal and trans-abdominal surgeries are separated because of major differences in their processes. As a result, several specialized organizations, including the American College of Radiology, organized a task force to develop a code outlining a more comprehensive method for evaluating and measuring fetal traits. 

It was determined by the task group that the obstetric ultrasound codes needed to be revised and that new codes were required to reflect current technological advancements.

 Adding five new codes (76801, 76802, 76811, 76812, and 76817) and updating four code descriptions were among the group’s recommendations for the prior “Pelvic” ultrasonography section (76805, 76810, 76815, and 76816).

 Diagnostic Ultrasound Pelvis has two new subheadings to distinguish between obstetrical and no obstetrical codes, which the CPT® Editorial Panel approved.

A vital aspect of the transvaginal examination, pelvic ultrasound, is not reimbursed independently. TV-US scans of the pelvic tissues are more comprehensive.

When a patient’s pelvic tissues are located within the bony pelvis, pelvic echography using an abdominal approach is identical to TV-US.

Trans-abdominal non-obstetrical ultrasonography in real-time with image documentation; CPT code 76856 completes the procedure. CPT code 76830 is used for a non-obstetrical trans-vaginal ultrasound.

Providers performing non-obstetrical or first-trimester obstetrical trans-abdominal ultrasounds later determine that an additional transvaginal ultrasound is necessary because the image is unclear and are eligible for reimbursement at 100 percent of the paid amount allowances for the additional transvaginal ultrasound only. 

Trans-abdominal ultrasound reimbursement will be 50 percent of the amount paid. Fung and colleagues observed three hundred-four women on tamoxifen prospectively and longitudinally over six years.

An annual TVU screening was performed on all participants, and an endometrial biopsy was performed on those who had abnormal results or were experiencing symptoms of bleeding. Forty-three percent of TVU tests revealed significant uterine abnormalities, demanding additional medical or surgical research and treatment. 

However, benign polyps accounted for eighty percent of the anomalies and did not necessitate treatment. Primary endometrial cancer has been detected in six women who had irregular bleeding.

Reimbursement

An ultrasound of the pelvic area performed during an office visit is only reimbursed for the cost of the transvaginal ultrasound if the physician decides that the image is ambiguous and the transvaginal ultrasound is necessary. 

Pelvic ultrasonography will be reimbursed at 50% of the authorized amount. A non-obstetrical or first-trimester obstetrical trans-abdominal ultrasound can be performed simultaneously with a transvaginal ultrasound when necessary. 

The health plan will be notified if a patient has two procedures on the same day and both are reported.

Examples

Suppose a woman goes to her gynecologist complaining about pain in her pelvis. She is given the option of getting an ultrasound exam that does not include an OB component.

Unfortunately, doctors discovered that she was pregnant during the examination. Now, how would this scenario be repotted? The doctor does the Non-OB exam in this case because only what has been done should be coded.

Therefore, CPT code 76830 can be billed appropriately.