cpt code 76830

(2022) CPT Code 76830 Description, Guidelines, Reimbursement, Modifiers & 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. 

CPT Code 76830 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.

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). 

76830 cpt code

The CPT codes for this procedure are 76856 and 76857, both of which relate to Pelvic Ultrasound. The uterus, adnexal structures, ovaries, endometrium, bladder, and a 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. For pelvic ultrasonic OB exams, the CPT codes 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 no pregnancy is present. 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 description

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. 

When it comes to 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 are eligible for reimbursement at 100 percent of the paid amount allowances for the additional transvaginal ultrasound only. 

CPT 76857

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.

CPT Code 76830 Billing Guidelines

This billing guideline regulation makes use of the CPT® or Current Procedural Terminology. CPT® has been trademarked by the American Medical Association (AMA). The American Medical Association owns all CPT® codes and descriptions. We maintain the right to all intellectual property rights.

 This list of CPT codes and CPT descriptions is based on current manuals and is meant for informational purposes only. They are not meant to be all-inclusive. Please note that the codes listed in this payment policy are only for your convenience.

 Coverage cannot be guaranteed just because a piece of code has been added or removed. Clinicians should reference the most up-to-date professional coding information available to get reimbursed.

The medical literature, government agency/program approval status, evidence-based guidelines and positions of leading national health professional organizations, and the views of physicians practicing in relevant clinical areas affected by this clinical policy were all considered in the development of this clinical policy by appropriately licensed and experienced health care professionals. 

In the formulation of this clinical policy, LHCC provides no promises or accepts no responsibility for the content of any external information used or relied upon. During establishing this clinical policy, current medical practice standards were considered.

Current Procedural Terminology® (CPT®) is referenced in this payment policy. The American Medical Association has trademarked CPT®. Additionally, the American Medical Association owns the rights to all CPT® codes and descriptions. 

Any intellectual property rights are explicitly disclaimed. CPT codes and descriptions are taken from current manuals and are provided solely for informational purposes; they are not intended to be exhaustive. This payment policy’s use of codes is only informational. 

There is no guarantee of coverage if any codes are included or excluded. Before submitting claims for reimbursement of covered services, providers should consult the most current sources of professional coding guidance.

CPT Code 76830 Modifiers

A modifier is neither necessary nor authorized when charging for a split-billable claim’s professional and technical service components. Therefore, this modification does not apply to combined bills for CPT code 76830 and 76856. 

Medicare and Medicaid (CMS) rules allow for several procedure payment reductions when several treatments from practice are performed on the same patient in one day and one session.

Unfortunately, there are no instructions regarding transvaginal coding. It is not apparent if this was a mistake. 

Propose billing the transvaginal code only once if the doctor counts the number of gestational sacs during the scan. In addition, transvaginal scans check on certain parameters, such as the fetus’s viability. 

However, they can also be used in conjunction with an abdominal approach to assist the clinician in properly visualizing all structures of interest. An abdominal scan can obtain a more accurate picture of the fetal anatomy in many pregnancies rather than a transvaginal one.

Ultrasonography imaging of the female pelvic organs and tissues is achieved by a non-invasive process known as trans-abdominal ultrasound. An ultrasound of the female trans-abdominal organs and structures includes the uterus, cervix, vagina, fallopian tubes, ovaries, and other reproductive organs.

 A transducer is stroked back and forth over the lower abdomen to obtain an image of the uterus, ovaries, and neighboring trans-abdominal structures. This is a report from an independent party.

The bulk of clinical labor actions is not repeated when a physician obtains many non-obstetrical ultrasound images in a single session. Procedure-related clinical labor costs are included in the provider reimbursement. 

Additionally, it is rare for the same materials to be used throughout various procedures. Due to duplication of clinical labor activities that were previously performed just once, multiple procedure payments change provider remuneration to compensate for this.

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 medically 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? Because only what has been done should be coded, the doctor does the Non-OB exam in this case.

Therefore, CPT codes 76801 and 76817 are not appropriate for this graphic.

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