2018 Coding and Reimbursement Guide – Fertility Assessment with Sono HSG / SIS POSSIBLE DIAGNOSIS CODES ICD-10 Codes Other Procedures, Code Descriptors N73.6 Female pelvic peritoneal adhesions (postinfective) 76376 3D rendering with interpretation and reporting of N97.1 Female infertility of tubal origin computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with N97.2 Female infertility of uterine origin image postprocessing under concurrent supervision; N97.8 Female infertility of other origin not requiring image postprocessing on an N97.9 Female infertility, unspecified independent workstation Z31.41 Encounter for fertility testing 76830* Transvaginal Ultrasound, non-obstetric 76856* Ultrasound, pelvic (non-obstetric), real time with CPT Codes that Describe the image documentation; complete Sono HSG / SIS Procedure with ABBI 58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) CPT Code Modifiers or hysterosalpingography – 59 Distinct Procedural Service: Indicates a procedure 76831* Saline infusion sonohysterography (SIS), including color or service that is distinct or independent from other flow Doppler when performed services performed on that same day. * Code 76831 includes all ultrasound imaging performed during the hysterosonography procedure. It is not appropriate to separately report transvaginal or pelvic ultrasound (76830, 76856) performed as an inherent part of the hysterosonogram. If a diagnostic ultrasound is performed as a separate procedure prior to hysterosonography, report the applicable code with modifier -59 appended. Sources: • 2018 AMA CPT Professional Edition • CPT Assistant March 2009, Volume 19, Issue 3, pages 10 - 11 • 2018 International Classification of Diseases, 10 revision Clinical Modification (ICD-10-CM) Reimbursement information is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. CooperSurgical encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. CooperSurgical recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. CooperSurgical does not promote the use of its products outside their FDA-approved label. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All rights reserved. CPT® is a trademark of the AMA. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. For more information, call 800.243.2974 or 203.601.5200 or visit www.coopersurgical.com. ©2018 CooperSurgical, Inc. 82596 Rev. 1/18.