In-office HSG to visualize contrast dye

I looked at the coding corner site and found the below info which I find helpful. However, I have a question that is not addressed. If the HSG is performed in our office and not at a facility and fluoroscopy is provided, but isn’t necessarily used for needle placement but to see the contrast and dye, 77002 would not be the correct code, would it? For the fluoroscopy piece, would 76496, unlisted fluoroscopic procedure, be more appropriate. The 74740 is for the radiologic supervision and interpretation but not for the fluoroscopic portion on an HSG. Thoughts? Is there another better fluoroscopic code that should be used? HSG Denied as Bundled or Incidental I posted this coding question to the ARM discussion thread last week and didn’t get any responses. I’ve also gone through your old coding posts and cannot find this specific question. Is there someone on your team that could answer this question please? This is what we are currently using and was recommended by the rep: 58340, 77002, Q9967, 74740, 99213-25 77002 commonly is being denied as bundled or incidental and most recently we are having problems with Anthem for the office visit. 58340 is the code used for catheterization and introduction of contrast for hysterosalpingography. This is billed in conjunction with code 74740, radiologic supervision and interpretation, which consists of a professional component (for interpretation of the images) and a technical fee. Fees for the technical component are reimbursed to the facility or practice responsible for these costs. The two components of 74740 can be billed together or as separate services. When the HSG is performed at a hospital facility and the images are interpreted by a Radiologist, the hospital collects the technical component (TC) portion of the fee, and the Radiologist collects the professional component (PC) of 74740. Third party payers will only pay once for Interpretation of the images, so a gynecologist may not bill for the professional component of this code if a Radiologist is providing an interpretation of the images. If not, then you may submit 74740, and if you own the equipment and facility, you may bill for both the technical and facility components. 74740 includes all the radiologic services necessary to complete the service, so 77002 (“Fluoroscopic guidance”) is bundled into procedure code 74740 and should NOT be reported separately. HCPCS code Q9967 is for low osmolar contrast material, 300-399 mm/ml and is reported, per ml. If the site of service is also required, code 11 represents an office, code 22 designates an outpatient hospital, and code 24 is used for an ambulatory surgical center. As for an office (E/M) visit billed on the same day as the procedure, if doing so, you would use a -25 modifier. However, this should ONLY be done when the E/M visit contains SIGNIFICANT, SEPARATELY IDENTIFIABLE services, above and beyond the work typically associated with the procedure, and best using a separate diagnosis code as well. • "Significant" suggests that some level of history, examination or medical decision making is involved. • "Separately identifiable" means the E/M must be distinct form the procedure. Merely informing the patient that the HSG procedure is normal would be considered usual care normally associated with performing the procedure. However, if the findings prompt an extensive discussion, including a review of the images, an explanation of the potential impact on fertility and a review of the treatment options and outcomes, then you can code for these additional services. You must document your discussion and/or the time spent with the patient and make sure the documentation clearly indicates the distinct nature of both services. A better option might be to defer this full discussion until a return visit by the patient on a separate date. The ICD-10 diagnosis code for fertility testing is Z31.41 Hysterosalpingo Contrast Sonography As a new practice, we are having trouble finding the appropriate code for HyCoSy (Hysterosalpingo Contrast Sonography -an SIS/SHG that includes the fallopian tubes and air bubbles in the saline via catheter.) Since it is a relatively new procedure, we would love some guidance or maybe feedback from other practices who perform it. There is no specific code for HyCoSy but, since it is like performing a sonohysterogram, the following codes should be used in combination: • 58340: catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography. • 74740: radiologic supervision and interpretation.

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