CPT Knowledgebase - Apr 3, 2009
What is the appropriate code to report a hysterosal-pingogram performed under ultrasound rather than fluoroscopy? For the catheterization component, a catheter is inserted into the uterus and injection is performed. A second catheter is then lodged in the tubal ostium for injection of contrast directly into the fallopian tube. The catheter is advanced no further. Is this code 58340 or 58345? CPT code 58340 seems understated since a catheter must be maneuvered to the tubal os, but code 58345 seems overstated since the fallopian tube is not recannulized. For the radiologic component, the contrast is echogenic and followed on ultrasound (typically transabdominal). CPT code 76831 is for ultrasound but seems limited to the uterus, not the fallopian tubes. CPT code 74740 is specifically for hysterosalpingography but it is not clear whether it is restricted to fluoroscopy or it can also be reported for ultrasound. Answer: The appropriate codes to report are CPT code 58340, Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography, and CPT code 76831, Saline infusion sonohysterography (SIS), including color flow Doppler, when performed. Physicians now perform in vitro fertilization (IVF) and bypass tubal obstructive disease procedures in infertility management, making the combination of CPT code 58345, Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography, and CPT code 74742, Transcervical catheterization of fallopian tube, radiological supervision and interpretation, now rarely performed (originally performed under fluoroscopy).To view the Official AMA answer and 1000s more like this:
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