A: A translabial ultrasound performed using a probe that is different from that used for a transvaginal ultrasound and that does not enter the vagina is appropriately coded using either a nonobstetrical pelvic or obstetrical ultrasound code.
Translabial or transperineal ultrasound is occasionally performed for determining cervical effacement in a late third trimester pregnancy to check the inferior placental margin without resorting to a transvaginal probe, or to evaluate a labial or perineal mass. Since these indications are all part of a nontransvaginal ultrasound evaluation of the pelvis or a pregnancy, the appropriate pelvic (eg, 76856) or obstetrical ultrasound code (eg, 76805) should be used. If the study is limited to translabial or transperineal scans, and a complete transabdominal study is not performed, the appropriate limited pelvic (eg, 76857) or other limited obstetrical ultrasound code (eg, 76815) should be used. If a complete transabdominal ultrasound of the pelvis or transabdominal obstetrical ultrasound study is also performed, then the respective translabial examination is included and not coded separately.
A: It is not appropriate to report code 76986 (ultrasonic guidance, intraoperative) when a duplex scan is performed to verify intraoperatively the functioning of a newly created graft or fistula for dialysis. Code 76986 describes an intraoperative ultrasound guidance procedure, not final verification. This is a code intended to be used for localization. It is not intended to be used to show that something works, such as a newly created graft or fistula for dialysis.
If a full and complete duplex study were performed, it would be appropriate to report 93990 (duplex scan of hemodialysis access including arterial inflow, body of access, and venous outflow). If a duplex scan were performed for patency only, report 93990 with the –52 modifier to indicate the study was limited.