acknowledges the importance of ultrasound visualization as a tool in the
evaluation of abnormalities or complaints referable the female pelvis. The
evaluation of female pelvic signs and symptoms should progress through an
orderly process of obtaining an appropriate history and performance of a pelvic
examination. If an abnormality is detected on physical examination which needs
further elucidation, or if the appropriate course of treatment is unclear, a
high-quality, well documented complete ultrasound examination of the pelvis is
warranted to assure that all anatomic structures, normal and abnormal, are
visualized. This examination should be carefully documented to permit future
When 76830 is
billed in conjunction with 76856, to indicate that both trans-abdominal and
transvaginal examinations were conducted at the same visit in order to establish
complete visualization of the pelvic anatomy, the payment for the 76830 will be
reduced by 50% to reflect its status as a secondary procedure.
views the use of a limited transvaginal ultrasound as an appropriate study to
follow pelvic abnormalities seen on previous imaging studies. QualChoice would
expect documentation of the previously noted problem and documentation of the
measurement of the current examination compared with the previous examination.
screening ultrasound in asymptomatic women to check for signs of ovarian cancer
has been studied and has not been supported in the literature. QualChoice deems
this use of ultrasound to be experimental and therefore not covered.
non-Obstetrical Transvaginal Ultrasound is covered as an examination for ovarian
cancer when 2 or more of the following symptoms have been present continuously
for 2 weeks or more:
abdominal pain; OR
eating or feeling of fullness on eating; OR
frequency or urgency; OR
A pelvic exam
has revealed a suspicion of ovarian mass.
Transvaginal Ultrasound is considered medically necessary in the evaluation of a
woman who has a positive pregnancy test and symptoms of pain or bleeding
suggesting that an ectopic pregnancy may be present. 76830 should not be used as
the billing code for this procedure. Use 76817 instead.
indications for isolated, transvaginal Ultrasonography are limited, and there
are indications for which the examination is excluded from coverage, QualChoice
will audit high volume providers retrospectively for compliance with this
policy. QualChoice will expect to find all of the following present in the
materials submitted to substantiate charges during an audit:
and physical examination will be documented.
There will be
a dictated report for the procedure. That report will include:
indication for the procedure.
whether the examination was considered to be a complete assessment of the pelvis
or only an incomplete examination. If the latter, reference should be made to
the date ad findings of a previous complete examination
findings of the examination, including the evaluation and measurement of all
pelvic structures, including the uterus, both fallopian tubes, both ovaries, and
any pathologic structures encountered (or an indication of their absence based
on some other evidence).
Codes Used In This BI:
76830 Transvaginal us non-ob
76856 Us exam pelvic complete
76857 Us exam pelvic limited