76805 Vs 76817

Hi
When we billed the CPT® 76805 with dx V22.1 and CPT® 76817 with dx V22.1 insurance pay the CPT® 76805 and Denying the CPT® 76817 as Procedure not supported by Diagnosis - Requested procedure is not reimbursable based on diagnosis submitted. Can any body help to resolve this matter.
Thank You Braddy

re: 76805 Vs 76817

Were both transabdominal & transvaginal ultrasounds done? V22.1 indicates supervision of a normal pregnancy. It sounds as though the payer is questioning medical necessity of both services. You will likely need to show some symptoms, or indication of potential problems to get both paid.

re: 76805 Vs 76817

[Were both transabdominal & transvaginal ultrasounds done? V22.1 indicates supervision of a normal pregnancy. It sounds as though the payer is questioning medical necessity of both services. You will likely need to show some symptoms, or indication of potential problems to get both paid. ]

Hi Deested,
Both where performed the record states as "History: Dating sonogram, LMP 3/3/2014 Comment: Obstetrical sonography was performed both transabdominally and transvaginally.
Impresion states as "Tiny cystic structure within the endometrium measuring 3 mm. this is an indeterminate finding, could potentially represent an early gestational sac. Recommend correlation with LMP and beta-hCG levels. Follow up can be obtained as clinically indicated.'
Please advise
Braddy

re: Vs 76817

76805 is for > or = 14 weeks, check the documentation and make sure the weeks of gestation fit the code. Can you determine why the transvaginal ultrasound is being done? Usually it is because the gestation is short and a regular ultrasound would be ineffective.