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.
Login now to view this Coding information. Coding Resources are available to ASRM Members only.
If you are not an ASRM member and would like to be, visit the Membership Tab above.
Coding Q&A
View more Coding Q&A in this category
Guidance for coding limited or follow-up ultrasounds used during an IVF Cycle
I am a coder for a Reproductive Endocrinologist's office and am looking for some guidelines on limited or follow-up ultrasounds used during an IVF Cycle.
Shipping of frozen embryos
I have some infertility coverage, under which my insurance said they will cover frozen embryo shipping/transport from one facility to another.
Measurements to report with ultrasound codes
Are there clear guidelines as to what measurements are required in order to bill for each type of ultrasound?
Exclusion of IVF services due to Z31.83
My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000).Coding Corner
Coding Corner is segmented into the following sections. Click an image below to view questions and answers in that section.
More Resources
ASRM Academy on the Go
ASRM MAC Tool 2021
The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.
Practice Guidance
EMR Shared Phrases/Template Library
This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.
ASRM Practice Documents
These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.
ASRM Ethics Opinions
Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Practice Guidance
Coding Corner Q & A
The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.
Practice Guidance
COVID-19 Resources
A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.
Patient Resources
ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.
Topic Resources
View more on the topic of hysterosalpingogram (HSG)
Coding for fluid aspiration during HSG
For physician-performed sonoHSG (58340& 76831) and uterine aspiration due to fluid, can an additional code for the aspiration be billed? View the Answer
Q9967 for HSG
When is it appropriate to bill Q9967 for an HSG? View the Answer
SHG/HSG
If the answer is “if you perform the injection of contrast for an HSG at a radiology facility, you can report 58340: introduction of saline or contrast.” View the Answer
In-office HSG to visualize contrast dye
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 ... View the Answer
HSG Denied As Bundled Or Incidental
We are using and was recommended by the rep: 58340, 77002, Q9967, 74740, 99213-25 77002 commonly is being denied as bundled or incidental. View the Answer
Hysterosalpingo Contrast Sonography
What is the appropriate code for HyCoSy? View the Answer
ASRM position statement on qualifications for providing ultrasound procedures in reproductive medicine (2022)
ASRM affirms that completion of fellowship training in reproductive endocrinology and infertility meets the criteria for requisite education. View the Position StatementTopic Resources
View more on the topic of insurance
Billing 58558 together with 58560
Can CPT codes 58558 and 58560 be billed together? Also, can 58560 be billed with place of service 11? View the Answer
IVF coverage denied for Z31.83 diagnosis code
My wife and I have been seeking IVF treatment and coverage was added for infertility treatment (up to $25,000) but our insurer keeps denying it. View the Answer
Cycle coordination fees and 99499, S4042
I reviewed cycle coordination fees, but see that there is no specific code for cycle management. View the Answer
Reimbursement for cost of donor egg
My wife and I are going through a fertility treatment process, and we have purchased a donor egg out-of-pocket from a donor bank. View the Answer
Coding for Ovarian tissue cryopreservation, experimental or not?
For Cryopreservation; Reproductive Tissue Ovarian- 0058T code is not being recognized. Is there an updated one being used or a replacement of this code? View the Answer
Supervising provider for embryology billing
We typically bill our IVF Lab work under the rendering provider who performs the VOR. Who should be the supervising provider for embryology billing? View the Answer
Billing 58558 and 58560 together
Can CPT codes 58558 and 58560 be billed together? Also, can 58560 be billed with place of service 11? View the Answer
Endometrioma
Surgery was performed under anesthesia for Aspiration of right hyrosalpinx fluid and right endometrioma. View the Answer
Total versus Free estradiol
Should patients with fertility issues be billing Estradiol Free (82681) instead of Estradiol Total (82670)? View the Answer
Unlisted Fertility Treatment CPT Code
Can you please refer me to an unlisted management CPT code for fertility treatment? View the Answer
Vitamin D Testing in Infertility Patients
We are being told that, as of this year, vitamin D level screening is not being covered by many insurers. View the Answer
Z Codes Vs. Procedure Codes For Fertility Preservation Counseling
I am trying to understand better when to use the procreative management code vs the fertility preservation counseling and procedure codes. View the Answer
ICD-10 Code For Intrauterine Insemination (IUI) For Same-Sex Couple
Which ICD-10 code you recommend for IUI same gender couples? View the Answer
In-office HSG to visualize contrast dye
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 ... View the Answer
Initial Visit for Infertility With No Mandated Coverage
What code would be appropriate for an initial visit for infertility? View the Answer
Non-REI Board Certified MD Performing REI Procedures
My boss has a few follow up questions about a non-REI board certified MD performing REI procedures. View the Answer
Embryo Culture Denied As Experimental
We have received denials from insurance payers when billing CPT code 89251. View the Answer
Flat Fee For Outside Monitoring
Can our office charge outside monitoring patients a flat fee to be seen? View the Answer
Frozen Embryo Transport
What is the code for the cost of frozen embryo transport? View the Answer
Global Billing Vs Billing Under Provider
For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider? View the Answer
Diagnosis Codes For Intrauterine Insemination (IUI)
I was reviewing your Coding Corner information to find a definitive diagnosis for IUI procedures. Which diagnosis is the most appropriate? View the Answer
Donor Egg-Retrieval On Recipient's Claim
Is the donor egg retrieval included on the bill to insurance with the first IVF treatment for the recipient? View the Answer
Billing at an Outside Clinic for Lab Services
One of my physicians uses an outside facility to perform the retrievals and transfers. View the Answer
Billing For Cryopreservation Of Embryos Under The Male Partner
Can 89258 be billed under the male partner of a female patient? View the Answer
Billing For Procedures Performed By Outside Physicians
Our physician tested positive for COVID-19, so another physician not associated with our office performed our egg retrievals and embryo transfers. View the Answer
Board Certified Vs. Non-Board Certified Billing
Is coding/billing any different when a non-board certified or non-REI provider submits for REI procedure? View the Answer
Claim Form for Donor Egg Retrieval
What bill form is used of IVF donor egg retrieval? View the Answer
Coding For Alpha-Fetoprotein Testing
My clinic is looking into implementing Alpha-Fetoprotein (AFP) testing. I understand there is currently no CPT code listed for this testing. View the Answer
Coding For Donor Egg Retrieval For Male Intended Parent
In coding a donor-egg retrieval to bill to insurance under the male intended parent, would it be appropriate to use the Z31.83? View the Answer
Male Infertility
A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary
Mental-health Services During Assisted Reproduction
A summary of codes for Mental-health Services During Assisted Reproduction compiled by the ASRM Coding Committee. View the Coding Summary
PCOS
A summary of codes for PCOS as compiled by the ASRM Coding Committee. View the Coding Summary
Recurrent Pregnancy Loss (RPL)
Strategy for coding for a patient with RPL - codes compiled by the ASRM Coding Committee. View the Coding Summary
Laboratory Procedures during ART Cycles
A listing of codes, compiled for a fresh ART cycle, transfer, biopsy, cryopreservation of embryos and oocytes, storage, and thawing. View the Coding Summary
Embryo Transfer
A summary of Embryo Transfer codes collected by the ASRM Coding Committee View the Coding Summary
Endometriosis
A summary of common codes for Endometriosis compiled by the ASRM Coding Committee View the Coding Summary
Fibroids
A summary of codes to use with fibroids and myomas compiled by the ASRM Coding Committee View the Coding Summary
Fertility Preservation
A summary of codes for Fertility Preservation compiled by the ASRM Coding Committee. View the Coding Summary
Jan 2022: Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
At the September 2021 CPT Editorial Panel Meeting, a new Modifier was accepted to describe real-time telemedicine services. View the Letter
Feb 2021: CMS holds physicians harmless from Merit-based Incentive Payment System (MIPS) penalties amid COVID-19 Public Health Emergency
CMS announced it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency. View the Letter
Jan 2021: Coding for COVID-19 Vaccine Administration
AMA has published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations. View the Letter
Jan 2021: Telehealth Coding Extension and 2021 Medicare Physician Fee Schedule
Effective January 11, 2021, the U.S. Department of Health and Human Services' Secretary Azar has extended the COVID-19 Public Health Emergency (PHE). View the Letter
