Tuesday, October 25, 2016

CPT CODE 58340, 58555, 76831 - Catheterization hysterosalpingography procedure

procedure code and description


58340 - Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography (HSG)  - average fee payment - $230 - $240

58345 Transcervical introduction of fallopian tube catheter for diagnosis and/or reestablishing patency (any method), with or without hysterosalpingography

58555 Hysteroscopy, diagnostic (separate procedure)

58559 Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method

76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed

BACKGROUND

Sonohysterography (also referred to as “hysterosonography”, “saline infusion sonohysterography” (SIH), and “saline-injected uterine ultrasound”), involves the injection of a fluid into the cervix and uterus just prior to ultrasound of these structures. In general, saline is the fluid used for this procedure, although the use of gel preparations is now under study. The injected fluid aids in the visual imaging of the reproductive anatomy. Sonohysterography is normally an outpatient procedure and takes approximately 15 minutes. (ACOG, 2012, 2011). Saline infusion sonohysterography (SIS) is a useful imaging modality prior to planned hysteroscopic or laparoscopic procedures for fibroids, polyps, and uterine anomalies to ensure safe and appropriate interventions (Singh, & et al., 2013). Substantial evidence exists to indicate that sonohysterography is superior to transvaginal ultrasonography in the detection of intracavitary lesions, such as polyps and submucosal leiomyomas (ACOG, 2012).


Procedure  Code 58340

Claims for Procedure  code 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography) must be submitted hardcopy with attachments that indicate the purpose for and the radiological interpretation of the procedure.


Reimbursement for this procedure is limited to the assessment of fallopian tube occlusion or ligation following a sterilization procedure.



. Professional claims for procedure codes 58340 and 58345 must be filed with modifier FP. Paper claims require a type of service code “A” and modifier FP. Whether billing on paper or electronically, the primary detail diagnosis code for each procedure must be a family planning diagnosis code. The following instructions apply when procedures 58340 and 58345 are performed in an outpatient clinic associated with a hospital.

Claims for professional services provided in an outpatient clinic associated with a hospital must be filed with a type of service code “J”. Whether billing on paper or electronically, a family planning diagnosis code must be listed as primary on the claim detail.

When filing facility claims for 58340 and 58345, a primary diagnosis of family planning is required.




Contraindications

Sonohysterography should not be performed in a woman who is pregnant or who could be pregnant. This is usually avoided by scheduling the examination in the follicular phase of the menstrual cycle, after menstrual flow has essentially ceased but before the patient has ovulated. In a patient with regular cycles, sonohysterography should not in most cases be performed later than the 10th day of the menstrual cycle. Sonohysterography should not be performed in patients with a pelvic infection or unexplained pelvic tenderness, which could be due to pelvic inflammatory disease. Active vaginal bleeding is not a contraindication to the procedure but may make the
interpretation more challenging. (AIUM, 2011)

Limitations of Sonohysterography

Sonohysterography should typically not be performed in women with active pelvic inflammatory disease. In women with stenosis of the cervix, it may be somewhat difficult to insert the catheter into the cervical canal so that saline may be injected. Inadequate distension (expansion) of the uterine cavity from the saline injection may also prevent good-quality ultrasound images from being obtained. This can occur especially with uterine adhesions (scarring) or large benign tumors called fibroids, which may partially obliterate the uterine cavity. Also, sonohysterography is limited in the assessment of the patency, or openness, of the fallopian tubes because of their size and structure. In such cases where an abnormality of the fallopian tubes is suspected, a procedure such as hysterosalpingography might be recommended for further evaluation.

Saline sonohysterography for abnormal uterine bleeding is considered medically necessary for the following:

*  Abnormal uterine bleeding; OR,

*  Uterine cavity, especially with regard to uterine myomas, polyps, and synechiae; OR,

*  Abnormalities detected on endovaginal sonography, including focal or diffuse endometrial or intracavitary abnormalities; OR,

*  Congenital abnormalities of the uterus; OR,

*  Recurrent pregnancy loss.

Exclusions and Contraindications

Saline sonohysterography for abnormal uterine bleeding is considered experimental and investigational for indications not listed above and therefore is not considered medically necessary. Further conclusions about the safety and effectiveness of this technology cannot be made until a full assessment has been completed. Abnormal uterine bleeding can be managed by other alternative options such as a dilatation and curettage (D&C), hysteroscopy with or without biopsy, or transvaginal ultrasound with or without endometrial biopsy or D&C.

Sonohysterography is contraindicated for women: 10

*  Who are pregnant or who could be pregnant; OR,

*  With a pelvic infection or unexplained pelvic tenderness (could be due to pelvic inflammatory disease)

Active vaginal bleeding is not a contraindication to the procedure however interpretation may be more challenging.


Covered Procedure  Codes

58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS)  or hysterosalpingography

76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed

Modifiers

In some cases, adding a modifier to the code may be necessary. Because Essure is considered a preventive service, add a modifier (33) to the procedure code (58565) and Essure Confirmation Test code (58340).

Procedure  Modifier 33 is applicable for the identification of preventive services without cost sharing in 4 categories. Essure and the HSG fall under category 4: Preventive care and screenings provided for women (not included in the US Preventive Services Task Force A or B rating) in the comprehensive guidelines supported by the Health Resources and Services Administration.

Note: Not all commercial payers will require the use of Modifier 33. Some will automatically process the Essure procedure and the Essure Confirmation Test without patient cost sharing.

Rationale for Edit:

Anthem Central Region bundles 58555 as incidental with 58260. Following the CPT guidelines for Separate Procedures, this states:

“The codes designated as ‘separate procedure’ should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.”  Therefore, if 58555 is submitted with 58260—only 58260 reimburses

Anthem Central Region bundles 76830 as incidental with 76831, but 76830-59 does not bundle with 76831. Based on CPT Assistant, article Hysterosonography and Hysterosalpingography:

What's Included?

Code 76831 describes the imaging portion of the hysterosonography procedure. As indicated in the nomenclature of this code "with or without color flow Doppler is used during hysterosonography. Also, it would not be appropriate to separately report transvaginal ultrasound (76830) performed as an inherent part of the hysterosonogram. CPT code 76831 includes all ultrasound imaging performed during the hysterosonography procedure. However, if a transvaginal pelvic ultrasound is performed as a separate procedure prior to hysterosonography,  this should be reported using code 76830 (echography, transvaginal). The modifier -59 should be appended in this instance.

Therefore, if 76830 is submitted with 76831--only 76831 reimburses, but if 76830-59 is submitted with 76831—both reimburse separately.

If on appeal, it documented that a separate transvaginal ultrasound (76830), is performed prior to the hysterosonography (76831), both may reimburse separately.


Covered ICD-9-CM Diagnosis Codes

626.8 Dysfunctional or functional uterine hemorrhage NOS
626.9 Dysfunctional or functional uterine hemorrhage unspecified
626.6 Metrorhagia
627.0 Premenopausal menorrhagia

Covered Draft ICD-10-CM Diagnosis Codes

N92.1 Excessive and frequent menstruation with irregular cycle
N89.7 Hematocolpos
N92.5 Other specified irregular menstruation
N93.8 Other specified abnormal uterine and vaginal bleeding
N92.6 Irregular menstruation, unspecified
N93.9 Abnormal uterine and vaginal bleeding, unspecified
N92.4 Excessive bleeding in the premenopausal period

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