Reimbursement Advisor

Payers discourage multiple sonograms

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Q Can we bill for a 3-dimensional (3D) sonogram (76375), a transvaginal sonogram (76830), and a hysterosonogram at the same encounter or session? Our physicians do both the injection procedure (58340) and the ultrasound component (76831) and the 3D as well because they say they get a better picture.

A Your question involves 3 issues that I will address separately.

Transvaginal ultrasound

This procedure is included as part of 76831 (Saline infusion sonohysterography [SIS], including color flow Doppler, when performed). Transvaginal ultrasound should not be billed in addition unless it was performed to document a problem not related to the hysterosonogram. The ACOG coding manual agrees; it indicates that a transvaginal ultrasound should not be reported separately because it is included in the global service when performed. Since the Correct Coding Initiative (CCI) also bundles this code combination, you could bill it only if it was done during a separate session. A modifier -59 (Distinct procedural service) would be added to 76831 because this procedure is bundled into the code for the transvaginal ultrasound.

3D ultrasound

Your second coding problem is performing a 3D ultrasound at the time of the hysterosonogram. Here, there are 2 issues: insurance coverage and billing.

Many payers do not reimburse for 3D ultrasound because they consider it experimental—and none reimburse 3D ultrasound when done routinely. Medical necessity must be established for 3D rendering. Be sure to inform your patients that this procedure may not be covered by their insurance company, so that they can make an informed choice.


The CPT code you indicated, 76375, has been replaced by 2 new codes:

  • Code 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation) and
  • Code 76377 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation).
CPT indicates that in order to bill either of these 2 new codes, a basic scan must be reported in addition. These 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.”

CPT does not stipulate which codes can serve as the basic scan, but as 76831 is an ultrasound procedure, the payer may allow it to be used in this fashion.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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