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SMFM Clinical Practice Guidelines


Coding and billing for transvaginal
ultrasound to assess second-trimester
cervical length
Society of Maternal Fetal Medicine with the assistance of
Andrew Helfgott, MD

Published in Contemporary OB/GYN / June 2013


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Technique M
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 Sonographic assessment of CL should be performed only by


individuals trained in the technique.
 A TVU CL assessment needs to be performed with proper
technique, quality control, and monitoring to yield accurate
results.
 To ensure quality, the Perinatal Quality Foundation convened a
cervix education task force in November 2011. The goal of the
task force was to develop a consensus educational program
that presented in a widely available format the standard criteria
for sonographic CL measurements during pregnancy.
 The Cervical Length Education and Review (CLEAR) program is
a product of the task force discussions. The CLEAR program
provides 3 lectures, an optional examination, and a scored
cervical image review. The lectures are available at no charge.
Documentation of completion of the CLEAR program, as well as
continuing medical education (CME) credits, will be provided
to those who complete the lectures and pass the examination
and the image review. More information is available at CLEAR:
Cervical Length Education and Review
(www.perinatalquality.org/CLEAR).3
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 When performed in low-risk, asymptomatic women for


purposes of preterm birth (PTB) screening, a single TVU CL
determination obtained between about 18 weeks’ and 24
weeks’ gestation is sufficient.
 Serial cervical exams are usually not indicated in low-risk
women, but they are appropriate in high-risk pregnancies
(ie, singleton gestations with prior PTB).
 Given reports that 57% of short CL on TVU are not detected
on transabdominal ultrasound and that the TVU screening
approach was the one used in all published trials, TVU is the
preferred approach for diagnosing cervical shortening.
 Payment for a single TVU examination performed between
18 and 24 weeks’ gestation for CL assessment in low-risk
patients (ie, singleton gestations without prior PTB) is
appropriate.
 When screening high-risk patients, a series of TVU CL
measurements can be performed every 2 weeks between
16 and 24 weeks.
The SMFM Coding Committee has provided the following S
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guidance for coding cervical screening: M

 CPT 76817, Ultrasound, pregnant uterus, real time with


image documentation, transvaginal. CPT Code 76817 may
be billed alone or with other ultrasound services at the same
session. If TVU for cervical screening is performed on the
same date of service as a transabdominal ultrasound
performed for other clinical indications, both ultrasound
procedures would be billed. For example:
 76805, Ultrasound, pregnant uterus, real time with image
documentation, fetal and maternal evaluation, after first
trimester (> or = 14 weeks 0 days), transabdominal
approach;
 CPT 76817, Ultrasound, pregnant uterus, real time with
image documentation, transvaginal;
 or 76811, Ultrasound, pregnant uterus, real time with
image documentation, fetal and maternal evaluation
plus detailed fetal anatomic examination,
transabdominal approach; single or first gestation;
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Major clinical implications of an isolated choroid plexus M
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 According to the 2012 American Medical


Association CPT:
 “If transvaginal examination is done in addition
to transabdominal obstetrical ultrasound exam,
use 76817 in addition to appropriate
transabdominal exam code.”
 Based on these guidelines, the use of Modifier
59 (Distinct Procedural Service) is not required.
However, should payors have specific internal
guidelines that require the use of Modifier 59; it
would then be attached to the transvaginal
ultrasound (CPT 76817).
The SMFM Coding Committee has provided the following S
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guidance for coding cervical screening: M

 The International Statistical Classification of Diseases


and Related Health Problems: ICD-9 (ICD-9-CM)
diagnosis code that is recommended for cervical
length assessment, in the absence of risk factors or
symptoms, is:
 V28.82 Encounter for screening for risk of pre-term
labor
 It is important to clearly document in the body of the
ultrasound report that a transvaginal approach was
used to assess CL.
 As always, the SMFM Coding Committee strongly
recommends that providers contact their local payors
to verify the specific coverage in each contract to
avoid delays in claim processing for these coding
combinations.
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Disclaimer M
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 The practice of medicine continues to


evolve, and individual circumstances will
vary. This opinion reflects information
available at the time of its submission for
publication and is neither designed nor
intended to establish an exclusive
standard of perinatal care. This
presentation is not expected to reflect the
opinions of all members of the Society for
Maternal-Fetal Medicine.
 These slides are for personal, non-
commercial and educational use only
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Disclosures M
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 This opinion was developed by the Publications Committee


of the Society for Maternal Fetal Medicine with the
assistance of Stanley M. Berry, MD, Joanne Stone, MD, Mary
Norton, MD, Donna Johnson, MD, and Vincenzo Berghella,
MD, and was approved by the executive committee of the
society on March 11, 2012. Dr Berghella and each member
of the publications committee (Vincenzo Berghella, MD
[chair], Sean Blackwell, MD [vice-chair], Brenna Anderson,
MD, Suneet P. Chauhan, MD, Jodi Dashe, MD, Cynthia
Gyamfi-Bannerman, MD, Donna Johnson, MD, Sarah Little,
MD, Kate Menard, MD, Mary Norton, MD, George Saade,
MD, Neil Silverman, MD, Hyagriv Simhan, MD, Joanne Stone,
MD, Alan Tita, MD, Michael Varner, MD) have submitted a
conflict of interest disclosure delineating personal,
professional, and/or business interests that might be
perceived as a real or potential conflict of interest in relation
to this publication.