RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Nonobstetric Pelvic Ultrasound

A56671

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Source Article ID
N/A
Article ID
A56671
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Nonobstetric Pelvic Ultrasound
Article Type
Billing and Coding
Original Effective Date
07/04/2019
Revision Effective Date
10/01/2023
Revision Ending Date
04/22/2024
Retirement Date
04/22/2024
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Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Nonobstetric Pelvic Ultrasound L37636.

Indications

76856 is a complete evaluation and must minimally include:

  1. Female: description and measurements of the uterus and adnexal structures, measurement of the endometrium and bladder, and a description of any pelvic pathology.
  2. Male: evaluation and measurement of the bladder, evaluation of the prostate and seminal vesicles and any pelvic pathology.

76857 is a limited study and typically focuses on one or more elements listed under 76856 and/or the reevaluation of one or more pelvic abnormalities.

Limitations

  1. Post voiding residual bladder volume is not reimbursable by CPT® codes 76856 and 76857. Measurement of post voiding residual should be billed using CPT® code 51798.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
76856 Us exam pelvic complete
76857 Us exam pelvic limited
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(641 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
A18.14 Tuberculosis of prostate
A56.11 Chlamydial female pelvic inflammatory disease
C45.1 Mesothelioma of peritoneum
C48.0 Malignant neoplasm of retroperitoneum
C48.1 Malignant neoplasm of specified parts of peritoneum
C48.2 Malignant neoplasm of peritoneum, unspecified
C48.8 Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C52 Malignant neoplasm of vagina
C53.0 Malignant neoplasm of endocervix
C53.1 Malignant neoplasm of exocervix
C53.8 Malignant neoplasm of overlapping sites of cervix uteri
C53.9 Malignant neoplasm of cervix uteri, unspecified
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C54.9 Malignant neoplasm of corpus uteri, unspecified
C55 Malignant neoplasm of uterus, part unspecified
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C56.9 Malignant neoplasm of unspecified ovary
C57.00 Malignant neoplasm of unspecified fallopian tube
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C57.10 Malignant neoplasm of unspecified broad ligament
C57.11 Malignant neoplasm of right broad ligament
C57.12 Malignant neoplasm of left broad ligament
C57.20 Malignant neoplasm of unspecified round ligament
C57.21 Malignant neoplasm of right round ligament
C57.22 Malignant neoplasm of left round ligament
C57.3 Malignant neoplasm of parametrium
C57.4 Malignant neoplasm of uterine adnexa, unspecified
C57.9 Malignant neoplasm of female genital organ, unspecified
C58 Malignant neoplasm of placenta
C61 Malignant neoplasm of prostate
C62.00 Malignant neoplasm of unspecified undescended testis
C62.01 Malignant neoplasm of undescended right testis
C62.02 Malignant neoplasm of undescended left testis
C62.10 Malignant neoplasm of unspecified descended testis
C62.11 Malignant neoplasm of descended right testis
C62.12 Malignant neoplasm of descended left testis
C62.90 Malignant neoplasm of unspecified testis, unspecified whether descended or undescended
C62.91 Malignant neoplasm of right testis, unspecified whether descended or undescended
C62.92 Malignant neoplasm of left testis, unspecified whether descended or undescended
C63.9 Malignant neoplasm of male genital organ, unspecified
C67.0 Malignant neoplasm of trigone of bladder
C67.1 Malignant neoplasm of dome of bladder
C67.2 Malignant neoplasm of lateral wall of bladder
C67.3 Malignant neoplasm of anterior wall of bladder
C67.4 Malignant neoplasm of posterior wall of bladder
C67.5 Malignant neoplasm of bladder neck
C67.6 Malignant neoplasm of ureteric orifice
C67.7 Malignant neoplasm of urachus
C67.8 Malignant neoplasm of overlapping sites of bladder
C67.9 Malignant neoplasm of bladder, unspecified
C76.3 Malignant neoplasm of pelvis
C79.63 Secondary malignant neoplasm of bilateral ovaries
D06.0 Carcinoma in situ of endocervix
D06.1 Carcinoma in situ of exocervix
D06.7 Carcinoma in situ of other parts of cervix
D06.9 Carcinoma in situ of cervix, unspecified
D07.0 Carcinoma in situ of endometrium
D07.1 Carcinoma in situ of vulva
D07.2 Carcinoma in situ of vagina
D07.30 Carcinoma in situ of unspecified female genital organs
D07.39 Carcinoma in situ of other female genital organs
D25.0 Submucous leiomyoma of uterus
D25.1 Intramural leiomyoma of uterus
D25.2 Subserosal leiomyoma of uterus
D25.9 Leiomyoma of uterus, unspecified
D26.0 Other benign neoplasm of cervix uteri
D26.1 Other benign neoplasm of corpus uteri
D26.7 Other benign neoplasm of other parts of uterus
D26.9 Other benign neoplasm of uterus, unspecified
D27.0 Benign neoplasm of right ovary
D27.1 Benign neoplasm of left ovary
D27.9 Benign neoplasm of unspecified ovary
D28.1 Benign neoplasm of vagina
D28.2 Benign neoplasm of uterine tubes and ligaments
D28.9 Benign neoplasm of female genital organ, unspecified
D29.0 Benign neoplasm of penis
D29.1 Benign neoplasm of prostate
D29.20 Benign neoplasm of unspecified testis
D29.21 Benign neoplasm of right testis
D29.22 Benign neoplasm of left testis
D29.30 Benign neoplasm of unspecified epididymis
D29.31 Benign neoplasm of right epididymis
D29.32 Benign neoplasm of left epididymis
D29.4 Benign neoplasm of scrotum
D29.8 Benign neoplasm of other specified male genital organs
D29.9 Benign neoplasm of male genital organ, unspecified
D39.0 Neoplasm of uncertain behavior of uterus
D39.10 Neoplasm of uncertain behavior of unspecified ovary
D39.11 Neoplasm of uncertain behavior of right ovary
D39.12 Neoplasm of uncertain behavior of left ovary
D39.8 Neoplasm of uncertain behavior of other specified female genital organs
D39.9 Neoplasm of uncertain behavior of female genital organ, unspecified
D40.0 Neoplasm of uncertain behavior of prostate
D41.3 Neoplasm of uncertain behavior of urethra
D41.4 Neoplasm of uncertain behavior of bladder
D41.8 Neoplasm of uncertain behavior of other specified urinary organs
D78.01 Intraoperative hemorrhage and hematoma of the spleen complicating a procedure on the spleen
D78.02 Intraoperative hemorrhage and hematoma of the spleen complicating other procedure
D78.21 Postprocedural hemorrhage of the spleen following a procedure on the spleen
D78.22 Postprocedural hemorrhage of the spleen following other procedure
E28.0 Estrogen excess
E28.1 Androgen excess
E28.2 Polycystic ovarian syndrome
E28.310 Symptomatic premature menopause
E28.319 Asymptomatic premature menopause
E28.39 Other primary ovarian failure
E28.8 Other ovarian dysfunction
E28.9 Ovarian dysfunction, unspecified
E36.01 Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating an endocrine system procedure
E36.02 Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating other procedure
E89.40 Asymptomatic postprocedural ovarian failure
E89.41 Symptomatic postprocedural ovarian failure
G97.31 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure
G97.32 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure
G97.51 Postprocedural hemorrhage of a nervous system organ or structure following a nervous system procedure
G97.52 Postprocedural hemorrhage of a nervous system organ or structure following other procedure
I72.3 Aneurysm of iliac artery
I72.9 Aneurysm of unspecified site
I80.211 Phlebitis and thrombophlebitis of right iliac vein
I80.212 Phlebitis and thrombophlebitis of left iliac vein
I80.213 Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.219 Phlebitis and thrombophlebitis of unspecified iliac vein
I80.241 Phlebitis and thrombophlebitis of right peroneal vein
I80.242 Phlebitis and thrombophlebitis of left peroneal vein
I80.243 Phlebitis and thrombophlebitis of peroneal vein, bilateral
I80.249 Phlebitis and thrombophlebitis of unspecified peroneal vein
I80.251 Phlebitis and thrombophlebitis of right calf muscular vein
I80.252 Phlebitis and thrombophlebitis of left calf muscular vein
I80.253 Phlebitis and thrombophlebitis of calf muscular vein, bilateral
I80.259 Phlebitis and thrombophlebitis of unspecified calf muscular vein
K35.200 Acute appendicitis with generalized peritonitis, without perforation or abscess
K35.201 Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.209 Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation
K35.210 Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211 Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219 Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.30 Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31 Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32 Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33 Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.80 Unspecified acute appendicitis
K35.890 Other acute appendicitis without perforation or gangrene
K35.891 Other acute appendicitis without perforation, with gangrene
K36 Other appendicitis
K37 Unspecified appendicitis
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine with unspecified complications
K50.10 Crohn's disease of large intestine without complications
K50.111 Crohn's disease of large intestine with rectal bleeding
K50.112 Crohn's disease of large intestine with intestinal obstruction
K50.113 Crohn's disease of large intestine with fistula
K50.114 Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.119 Crohn's disease of large intestine with unspecified complications
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 Crohn's disease of both small and large intestine with rectal bleeding
K50.812 Crohn's disease of both small and large intestine with intestinal obstruction
K50.813 Crohn's disease of both small and large intestine with fistula
K50.814 Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.819 Crohn's disease of both small and large intestine with unspecified complications
K50.90 Crohn's disease, unspecified, without complications
K50.911 Crohn's disease, unspecified, with rectal bleeding
K50.912 Crohn's disease, unspecified, with intestinal obstruction
K50.913 Crohn's disease, unspecified, with fistula
K50.914 Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K50.919 Crohn's disease, unspecified, with unspecified complications
K57.20 Diverticulitis of large intestine with perforation and abscess without bleeding
K57.32 Diverticulitis of large intestine without perforation or abscess without bleeding
K57.40 Diverticulitis of both small and large intestine with perforation and abscess without bleeding
K57.52 Diverticulitis of both small and large intestine without perforation or abscess without bleeding
K57.80 Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding
K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
K61.31 Horseshoe abscess
K61.39 Other ischiorectal abscess
K61.5 Supralevator abscess
K66.1 Hemoperitoneum
K66.8 Other specified disorders of peritoneum
K68.11 Postprocedural retroperitoneal abscess
K68.9 Other disorders of retroperitoneum
K91.61 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive system procedure
K91.62 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure
K91.840 Postprocedural hemorrhage of a digestive system organ or structure following a digestive system procedure
K91.841 Postprocedural hemorrhage of a digestive system organ or structure following other procedure
N13.9 Obstructive and reflux uropathy, unspecified
N21.0 Calculus in bladder
N30.01 Acute cystitis with hematuria
N30.11 Interstitial cystitis (chronic) with hematuria
N30.21 Other chronic cystitis with hematuria
N30.31 Trigonitis with hematuria
N30.41 Irradiation cystitis with hematuria
N30.81 Other cystitis with hematuria
N30.91 Cystitis, unspecified with hematuria
N31.0 Uninhibited neuropathic bladder, not elsewhere classified
N31.1 Reflex neuropathic bladder, not elsewhere classified
N31.2 Flaccid neuropathic bladder, not elsewhere classified
N31.8 Other neuromuscular dysfunction of bladder
N31.9 Neuromuscular dysfunction of bladder, unspecified
N32.0 Bladder-neck obstruction
N32.1 Vesicointestinal fistula
N32.2 Vesical fistula, not elsewhere classified
N32.3 Diverticulum of bladder
N32.81 Overactive bladder
N32.89 Other specified disorders of bladder
N32.9 Bladder disorder, unspecified
N33 Bladder disorders in diseases classified elsewhere
N35.016 Post-traumatic urethral stricture, male, overlapping sites
N35.116 Postinfective urethral stricture, not elsewhere classified, male, overlapping sites
N35.812 Other bulbous urethral stricture, male
N35.813 Other membranous urethral stricture, male
N35.814 Other anterior urethral stricture, male
N35.816 Other urethral stricture, male, overlapping sites
N35.819 Other urethral stricture, male, unspecified site
N35.82 Other urethral stricture, female
N35.912 Unspecified bulbous urethral stricture, male
N35.913 Unspecified membranous urethral stricture, male
N35.914 Unspecified anterior urethral stricture, male
N35.916 Unspecified urethral stricture, male, overlapping sites
N35.919 Unspecified urethral stricture, male, unspecified site
N35.92 Unspecified urethral stricture, female
N36.44 Muscular disorders of urethra
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms
N40.3 Nodular prostate with lower urinary tract symptoms
N41.0 Acute prostatitis
N41.1 Chronic prostatitis
N41.2 Abscess of prostate
N41.3 Prostatocystitis
N41.4 Granulomatous prostatitis
N41.8 Other inflammatory diseases of prostate
N41.9 Inflammatory disease of prostate, unspecified
N70.01 Acute salpingitis
N70.02 Acute oophoritis
N70.03 Acute salpingitis and oophoritis
N70.11 Chronic salpingitis
N70.12 Chronic oophoritis
N70.13 Chronic salpingitis and oophoritis
N70.91 Salpingitis, unspecified
N70.92 Oophoritis, unspecified
N70.93 Salpingitis and oophoritis, unspecified
N71.0 Acute inflammatory disease of uterus
N71.1 Chronic inflammatory disease of uterus
N71.9 Inflammatory disease of uterus, unspecified
N73.0 Acute parametritis and pelvic cellulitis
N73.1 Chronic parametritis and pelvic cellulitis
N73.2 Unspecified parametritis and pelvic cellulitis
N73.3 Female acute pelvic peritonitis
N73.4 Female chronic pelvic peritonitis
N73.5 Female pelvic peritonitis, unspecified
N73.6 Female pelvic peritoneal adhesions (postinfective)
N73.8 Other specified female pelvic inflammatory diseases
N73.9 Female pelvic inflammatory disease, unspecified
N74 Female pelvic inflammatory disorders in diseases classified elsewhere
N80.00 Endometriosis of the uterus, unspecified
N80.01 Superficial endometriosis of the uterus
N80.02 Deep endometriosis of the uterus
N80.03 Adenomyosis of the uterus
N80.101 Endometriosis of right ovary, unspecified depth
N80.102 Endometriosis of left ovary, unspecified depth
N80.103 Endometriosis of bilateral ovaries, unspecified depth
N80.109 Endometriosis of ovary, unspecified side, unspecified depth
N80.111 Superficial endometriosis of right ovary
N80.112 Superficial endometriosis of left ovary
N80.113 Superficial endometriosis of bilateral ovaries
N80.119 Superficial endometriosis of ovary, unspecified ovary
N80.121 Deep endometriosis of right ovary
N80.122 Deep endometriosis of left ovary
N80.123 Deep endometriosis of bilateral ovaries
N80.129 Deep endometriosis of ovary, unspecified ovary
N80.201 Endometriosis of right fallopian tube, unspecified depth
N80.202 Endometriosis of left fallopian tube, unspecified depth
N80.203 Endometriosis of bilateral fallopian tubes, unspecified depth
N80.209 Endometriosis of unspecified fallopian tube, unspecified depth
N80.211 Superficial endometriosis of right fallopian tube
N80.212 Superficial endometriosis of left fallopian tube
N80.213 Superficial endometriosis of bilateral fallopian tubes
N80.219 Superficial endometriosis of unspecified fallopian tube
N80.221 Deep endometriosis of right fallopian tube
N80.222 Deep endometriosis of left fallopian tube
N80.223 Deep endometriosis of bilateral fallopian tubes
N80.229 Deep endometriosis of unspecified fallopian tube
N80.30 Endometriosis of pelvic peritoneum, unspecified
N80.311 Superficial endometriosis of the anterior cul-de-sac
N80.312 Deep endometriosis of the anterior cul-de-sac
N80.319 Endometriosis of the anterior cul-de-sac, unspecified depth
N80.321 Superficial endometriosis of the posterior cul-de-sac
N80.322 Deep endometriosis of the posterior cul-de-sac
N80.329 Endometriosis of the posterior cul-de-sac, unspecified depth
N80.331 Superficial endometriosis of the right pelvic sidewall
N80.332 Superficial endometriosis of the left pelvic sidewall
N80.333 Superficial endometriosis of bilateral pelvic sidewall
N80.339 Superficial endometriosis of pelvic sidewall, unspecified side
N80.341 Deep endometriosis of the right pelvic sidewall
N80.342 Deep endometriosis of the left pelvic sidewall
N80.343 Deep endometriosis of the bilateral pelvic sidewall
N80.349 Deep endometriosis of the pelvic sidewall, unspecified side
N80.351 Endometriosis of the right pelvic sidewall, unspecified depth
N80.352 Endometriosis of the left pelvic sidewall, unspecified depth
N80.353 Endometriosis of bilateral pelvic sidewall, unspecified depth
N80.359 Endometriosis of pelvic sidewall, unspecified side, unspecified depth
N80.361 Superficial endometriosis of the right pelvic brim
N80.362 Superficial endometriosis of the left pelvic brim
N80.363 Superficial endometriosis of bilateral pelvic brim
N80.369 Superficial endometriosis of the pelvic brim, unspecified side
N80.371 Deep endometriosis of the right pelvic brim
N80.372 Deep endometriosis of the left pelvic brim
N80.373 Deep endometriosis of bilateral pelvic brim
N80.379 Deep endometriosis of the pelvic brim, unspecified side
N80.381 Endometriosis of the right pelvic brim, unspecified depth
N80.382 Endometriosis of the left pelvic brim, unspecified depth
N80.383 Endometriosis of bilateral pelvic brim, unspecified depth
N80.389 Endometriosis of the pelvic brim, unspecified side, unspecified depth
N80.3A1 Superficial endometriosis of the right uterosacral ligament
N80.3A2 Superficial endometriosis of the left uterosacral ligament
N80.3A3 Superficial endometriosis of the bilateral uterosacral ligament(s)
N80.3A9 Superficial endometriosis of the uterosacral ligament(s), unspecified side
N80.3B1 Deep endometriosis of the right uterosacral ligament
N80.3B2 Deep endometriosis of the left uterosacral ligament
N80.3B3 Deep endometriosis of bilateral uterosacral ligament(s)
N80.3B9 Deep endometriosis of the uterosacral ligament(s), unspecified side
N80.3C1 Endometriosis of the right uterosacral ligament, unspecified depth
N80.3C2 Endometriosis of the left uterosacral ligament, unspecified depth
N80.3C3 Endometriosis of bilateral uterosacral ligament(s), unspecified depth
N80.3C9 Endometriosis of the uterosacral ligament(s), unspecified side, unspecified depth
N80.391 Superficial endometriosis of the pelvic peritoneum, other specified sites
N80.392 Deep endometriosis of the pelvic peritoneum, other specified sites
N80.399 Endometriosis of the pelvic peritoneum, other specified sites, unspecified depth
N80.40 Endometriosis of rectovaginal septum, unspecified involvement of vagina
N80.41 Endometriosis of rectovaginal septum without involvement of vagina
N80.42 Endometriosis of rectovaginal septum with involvement of vagina
N80.50 Endometriosis of intestine, unspecified
N80.511 Superficial endometriosis of the rectum
N80.512 Deep endometriosis of the rectum
N80.519 Endometriosis of the rectum, unspecified depth
N80.521 Superficial endometriosis of the sigmoid colon
N80.522 Deep endometriosis of the sigmoid colon
N80.529 Endometriosis of the sigmoid colon, unspecified depth
N80.531 Superficial endometriosis of the cecum
N80.532 Deep endometriosis of the cecum
N80.539 Endometriosis of the cecum, unspecified depth
N80.541 Superficial endometriosis of the appendix
N80.542 Deep endometriosis of the appendix
N80.549 Endometriosis of the appendix, unspecified depth
N80.551 Superficial endometriosis of other parts of the colon
N80.552 Deep endometriosis of other parts of the colon
N80.559 Endometriosis of other parts of the colon, unspecified depth
N80.561 Superficial endometriosis of the small intestine
N80.562 Deep endometriosis of the small intestine
N80.569 Endometriosis of the small intestine, unspecified depth
N80.6 Endometriosis in cutaneous scar
N80.A0 Endometriosis of bladder, unspecified depth
N80.A1 Superficial endometriosis of bladder
N80.A2 Deep endometriosis of bladder
N80.A41 Superficial endometriosis of right ureter
N80.A42 Superficial endometriosis of left ureter
N80.A43 Superficial endometriosis of bilateral ureters
N80.A49 Superficial endometriosis of unspecified ureter
N80.A51 Deep endometriosis of right ureter
N80.A52 Deep endometriosis of left ureter
N80.A53 Deep endometriosis of bilateral ureters
N80.A59 Deep endometriosis of unspecified ureter
N80.A61 Endometriosis of right ureter, unspecified depth
N80.A62 Endometriosis of left ureter, unspecified depth
N80.A63 Endometriosis of bilateral ureters, unspecified depth
N80.A69 Endometriosis of unspecified ureter, unspecified depth
N80.8 Other endometriosis
N80.9 Endometriosis, unspecified
N82.8 Other female genital tract fistulae
N83.00 Follicular cyst of ovary, unspecified side
N83.01 Follicular cyst of right ovary
N83.02 Follicular cyst of left ovary
N83.10 Corpus luteum cyst of ovary, unspecified side
N83.11 Corpus luteum cyst of right ovary
N83.12 Corpus luteum cyst of left ovary
N83.201 Unspecified ovarian cyst, right side
N83.202 Unspecified ovarian cyst, left side
N83.291 Other ovarian cyst, right side
N83.292 Other ovarian cyst, left side
N83.53 Torsion of ovary, ovarian pedicle and fallopian tube
N83.6 Hematosalpinx
N83.7 Hematoma of broad ligament
N83.8 Other noninflammatory disorders of ovary, fallopian tube and broad ligament
N83.9 Noninflammatory disorder of ovary, fallopian tube and broad ligament, unspecified
N84.0 Polyp of corpus uteri
N84.8 Polyp of other parts of female genital tract
N84.9 Polyp of female genital tract, unspecified
N85.00 Endometrial hyperplasia, unspecified
N85.01 Benign endometrial hyperplasia
N85.02 Endometrial intraepithelial neoplasia [EIN]
N85.2 Hypertrophy of uterus
N85.3 Subinvolution of uterus
N85.4 Malposition of uterus
N85.5 Inversion of uterus
N85.6 Intrauterine synechiae
N85.7 Hematometra
N85.8 Other specified noninflammatory disorders of uterus
N85.9 Noninflammatory disorder of uterus, unspecified
N89.7 Hematocolpos
N91.0 Primary amenorrhea
N91.1 Secondary amenorrhea
N91.2 Amenorrhea, unspecified
N91.3 Primary oligomenorrhea
N91.4 Secondary oligomenorrhea
N91.5 Oligomenorrhea, unspecified
N92.0 Excessive and frequent menstruation with regular cycle
N92.1 Excessive and frequent menstruation with irregular cycle
N92.2 Excessive menstruation at puberty
N92.3 Ovulation bleeding
N92.4 Excessive bleeding in the premenopausal period
N92.5 Other specified irregular menstruation
N92.6 Irregular menstruation, unspecified
N93.0 Postcoital and contact bleeding
N93.1 Pre-pubertal vaginal bleeding
N93.8 Other specified abnormal uterine and vaginal bleeding
N93.9 Abnormal uterine and vaginal bleeding, unspecified
N94.0 Mittelschmerz
N94.4 Primary dysmenorrhea
N94.5 Secondary dysmenorrhea
N94.6 Dysmenorrhea, unspecified
N94.810 Vulvar vestibulitis
N94.818 Other vulvodynia
N94.819 Vulvodynia, unspecified
N94.89 Other specified conditions associated with female genital organs and menstrual cycle
N95.0 Postmenopausal bleeding
N98.1 Hyperstimulation of ovaries
N99.116 Postprocedural urethral stricture, male, overlapping sites
N99.510 Cystostomy hemorrhage
N99.511 Cystostomy infection
N99.512 Cystostomy malfunction
N99.518 Other cystostomy complication
N99.61 Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating a genitourinary system procedure
N99.62 Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating other procedure
N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure
N99.821 Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure
N99.83 Residual ovary syndrome
N99.85 Post endometrial ablation syndrome
O86.00 Infection of obstetric surgical wound, unspecified
O86.01 Infection of obstetric surgical wound, superficial incisional site
O86.02 Infection of obstetric surgical wound, deep incisional site
O86.03 Infection of obstetric surgical wound, organ and space site
O86.04 Sepsis following an obstetrical procedure
O86.09 Infection of obstetric surgical wound, other surgical site
Q50.01 Congenital absence of ovary, unilateral
Q50.02 Congenital absence of ovary, bilateral
Q50.1 Developmental ovarian cyst
Q50.2 Congenital torsion of ovary
Q50.31 Accessory ovary
Q50.32 Ovarian streak
Q50.39 Other congenital malformation of ovary
Q50.4 Embryonic cyst of fallopian tube
Q50.5 Embryonic cyst of broad ligament
Q50.6 Other congenital malformations of fallopian tube and broad ligament
Q51.0 Agenesis and aplasia of uterus
Q51.10 Doubling of uterus with doubling of cervix and vagina without obstruction
Q51.11 Doubling of uterus with doubling of cervix and vagina with obstruction
Q51.21 Complete doubling of uterus
Q51.22 Partial doubling of uterus
Q51.28 Other and unspecified doubling of uterus
Q51.3 Bicornate uterus
Q51.4 Unicornate uterus
Q51.5 Agenesis and aplasia of cervix
Q51.6 Embryonic cyst of cervix
Q51.7 Congenital fistulae between uterus and digestive and urinary tracts
Q51.810 Arcuate uterus
Q51.811 Hypoplasia of uterus
Q51.818 Other congenital malformations of uterus
Q51.820 Cervical duplication
Q51.821 Hypoplasia of cervix
Q51.828 Other congenital malformations of cervix
Q51.9 Congenital malformation of uterus and cervix, unspecified
Q52.0 Congenital absence of vagina
Q52.10 Doubling of vagina, unspecified
Q52.11 Transverse vaginal septum
Q52.120 Longitudinal vaginal septum, nonobstructing
Q52.121 Longitudinal vaginal septum, obstructing, right side
Q52.122 Longitudinal vaginal septum, obstructing, left side
Q52.123 Longitudinal vaginal septum, microperforate, right side
Q52.124 Longitudinal vaginal septum, microperforate, left side
Q52.129 Other and unspecified longitudinal vaginal septum
Q52.2 Congenital rectovaginal fistula
Q52.3 Imperforate hymen
Q52.4 Other congenital malformations of vagina
Q52.5 Fusion of labia
Q52.6 Congenital malformation of clitoris
Q52.70 Unspecified congenital malformations of vulva
Q52.71 Congenital absence of vulva
Q52.79 Other congenital malformations of vulva
Q52.8 Other specified congenital malformations of female genitalia
Q52.9 Congenital malformation of female genitalia, unspecified
Q53.00 Ectopic testis, unspecified
Q53.01 Ectopic testis, unilateral
Q53.02 Ectopic testes, bilateral
Q53.10 Unspecified undescended testicle, unilateral
Q53.111 Unilateral intraabdominal testis
Q53.112 Unilateral inguinal testis
Q53.12 Ectopic perineal testis, unilateral
Q53.13 Unilateral high scrotal testis
Q53.20 Undescended testicle, unspecified, bilateral
Q53.211 Bilateral intraabdominal testes
Q53.212 Bilateral inguinal testes
Q53.22 Ectopic perineal testis, bilateral
Q53.23 Bilateral high scrotal testes
Q53.9 Undescended testicle, unspecified
Q54.0 Hypospadias, balanic
Q54.1 Hypospadias, penile
Q54.2 Hypospadias, penoscrotal
Q54.3 Hypospadias, perineal
Q54.4 Congenital chordee
Q54.8 Other hypospadias
Q54.9 Hypospadias, unspecified
Q55.0 Absence and aplasia of testis
Q55.1 Hypoplasia of testis and scrotum
Q55.20 Unspecified congenital malformations of testis and scrotum
Q55.21 Polyorchism
Q55.22 Retractile testis
Q55.23 Scrotal transposition
Q55.29 Other congenital malformations of testis and scrotum
Q55.3 Atresia of vas deferens
Q55.4 Other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate
Q55.5 Congenital absence and aplasia of penis
Q55.61 Curvature of penis (lateral)
Q55.62 Hypoplasia of penis
Q55.63 Congenital torsion of penis
Q55.64 Hidden penis
Q55.69 Other congenital malformation of penis
Q55.7 Congenital vasocutaneous fistula
Q55.8 Other specified congenital malformations of male genital organs
Q55.9 Congenital malformation of male genital organ, unspecified
Q56.0 Hermaphroditism, not elsewhere classified
Q56.1 Male pseudohermaphroditism, not elsewhere classified
Q56.2 Female pseudohermaphroditism, not elsewhere classified
Q56.3 Pseudohermaphroditism, unspecified
Q56.4 Indeterminate sex, unspecified
Q64.0 Epispadias
Q64.11 Supravesical fissure of urinary bladder
Q64.5 Congenital absence of bladder and urethra
Q64.6 Congenital diverticulum of bladder
Q64.70 Unspecified congenital malformation of bladder and urethra
Q64.71 Congenital prolapse of urethra
Q64.72 Congenital prolapse of urinary meatus
Q64.73 Congenital urethrorectal fistula
Q64.74 Double urethra
Q64.75 Double urinary meatus
Q64.79 Other congenital malformations of bladder and urethra
R10.0 Acute abdomen
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R10.811 Right upper quadrant abdominal tenderness
R10.812 Left upper quadrant abdominal tenderness
R10.813 Right lower quadrant abdominal tenderness
R10.814 Left lower quadrant abdominal tenderness
R10.815 Periumbilic abdominal tenderness
R10.816 Epigastric abdominal tenderness
R10.817 Generalized abdominal tenderness
R10.819 Abdominal tenderness, unspecified site
R10.821 Right upper quadrant rebound abdominal tenderness
R10.822 Left upper quadrant rebound abdominal tenderness
R10.823 Right lower quadrant rebound abdominal tenderness
R10.824 Left lower quadrant rebound abdominal tenderness
R10.825 Periumbilic rebound abdominal tenderness
R10.826 Epigastric rebound abdominal tenderness
R10.827 Generalized rebound abdominal tenderness
R10.829 Rebound abdominal tenderness, unspecified site
R10.83 Colic
R10.84 Generalized abdominal pain
R10.9 Unspecified abdominal pain
R16.0 Hepatomegaly, not elsewhere classified
R16.1 Splenomegaly, not elsewhere classified
R16.2 Hepatomegaly with splenomegaly, not elsewhere classified
R18.0 Malignant ascites
R18.8 Other ascites
R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01 Right upper quadrant abdominal swelling, mass and lump
R19.02 Left upper quadrant abdominal swelling, mass and lump
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.06 Epigastric swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
R19.30 Abdominal rigidity, unspecified site
R19.31 Right upper quadrant abdominal rigidity
R19.32 Left upper quadrant abdominal rigidity
R19.33 Right lower quadrant abdominal rigidity
R19.34 Left lower quadrant abdominal rigidity
R19.35 Periumbilic abdominal rigidity
R19.36 Epigastric abdominal rigidity
R19.37 Generalized abdominal rigidity
R19.8 Other specified symptoms and signs involving the digestive system and abdomen
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.21 Asymptomatic microscopic hematuria
R31.29 Other microscopic hematuria
R31.9 Hematuria, unspecified
R39.11 Hesitancy of micturition
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
T81.40XA Infection following a procedure, unspecified, initial encounter
T81.40XD Infection following a procedure, unspecified, subsequent encounter
T81.40XS Infection following a procedure, unspecified, sequela
T81.41XA Infection following a procedure, superficial incisional surgical site, initial encounter
T81.41XD Infection following a procedure, superficial incisional surgical site, subsequent encounter
T81.41XS Infection following a procedure, superficial incisional surgical site, sequela
T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter
T81.42XD Infection following a procedure, deep incisional surgical site, subsequent encounter
T81.42XS Infection following a procedure, deep incisional surgical site, sequela
T81.43XA Infection following a procedure, organ and space surgical site, initial encounter
T81.43XD Infection following a procedure, organ and space surgical site, subsequent encounter
T81.43XS Infection following a procedure, organ and space surgical site, sequela
T81.44XA Sepsis following a procedure, initial encounter
T81.44XD Sepsis following a procedure, subsequent encounter
T81.44XS Sepsis following a procedure, sequela
T81.49XA Infection following a procedure, other surgical site, initial encounter
T81.49XD Infection following a procedure, other surgical site, subsequent encounter
T81.49XS Infection following a procedure, other surgical site, sequela
T88.8XXA Other specified complications of surgical and medical care, not elsewhere classified, initial encounter
Z48.22 Encounter for aftercare following kidney transplant
Z85.40 Personal history of malignant neoplasm of unspecified female genital organ
Z85.41 Personal history of malignant neoplasm of cervix uteri
Z85.44 Personal history of malignant neoplasm of other female genital organs
Z87.42 Personal history of other diseases of the female genital tract
Z87.59 Personal history of other complications of pregnancy, childbirth and the puerperium
Z94.0 Kidney transplant status
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Any ICD-10-CM code that is not listed in the ICD-10-CM Codes that Support Medical Necessity section of this article.

Group 1 Codes

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ICD-10-PCS Codes

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Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
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Other Coding Information

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/22/2024 R10

This article is being retired due to accepted standards of practice which have rendered the related Nonobstetric Pelvic Ultrasound L37636 Local Coverage Determination (LCD) ineffective.

10/01/2023 R9

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted K35.20, K35.21, added K35.200, K35.201, K35.209, K35.210, K35.211, K35.219 and the description was revised for N35.812. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/23.

10/01/2022 R8

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted N80.1, N80.2, N80.3, N80.4 and N80.5. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

10/01/2022 R7

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes the description was revised for K35.32 and K35.33, deleted N80.0, and added N80.A0, N80.A1, N80.A2, N80.A41, N80.A42, N80.A43, N80.A49, N80.A51, N80.A52, N80.A53, N80.A59, N80.A61, N80.A62, N80.A63, N80.A69, N80.00, N80.01, N80.02, N80.03, N80.101, N80.102, N80.103, N80.109, N80.111, N80.112, N80.113, N80.119, N80.121, N80.122, N80.123, N80.129, N80.201, N80.202, N80.203, N80.209, N80.211, N80.212, N80.213, N80.219, N80.221, N80.222, N80.223, N80.229, N80.30, N80.311, N80.312, N80.319, N80.321, N80.322, N80.329, N80.331, N80.332, N80.333, N80.339, N80.341, N80.342, N80.343, N80.349, N80.351, N80.352, N80.353, N80.359, N80.361, N80.362, N80.363, N80.369, N80.371, N80.372, N80.373, N80.379, N80.381, N80.382, N80.383, N80.389, N80.3A1, N80.3A2, N80.3A3, N80.3A9, N80.3B1, N80.3B2, N80.3B3, N80.3B9, N80.3C1, N80.3C2, N80.3C3, N80.3C9, N80.391, N80.392, N80.399, N80.40, N80.41, N80.42, N80.50, N80.511, N80.512, N80.519, N80.521, N80.522, N80.529, N80.531, N80.532, N80.539, N80.541, N80.542, N80.549, N80.551, N80.552, N80.559, N80.561, N80.562, N80.569. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

10/01/2021 R6

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added C56.3 and C79.63. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

04/24/2020 R5

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added N40.1 and N40.3.

10/17/2019 R4

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Nonobstetric Pelvic Ultrasound L37636 LCD and placed in this article. Under ICD-10 Codes that DO NOT Support Medical Necessity updated section heading.

10/01/2019 R3

Under Covered ICD-10 Codes Group 1: Codes the description changed for ICD-10 code N35.814 and ICD-10 codes I80.241, I80.242, I80.243, I80.249, I80.251, I80.252, I80.253, I80.259, and N99.85 were added. This revision is due to the 2019 Annual ICD-10 Code Update and is effective on October 1, 2019.

08/28/2019 R2

Under Covered ICD-10 Codes Group 1: Codes added R39.11.

07/25/2019 R1

All coding located in the Coding Information section has been removed from the related Nonobstetric Pelvic Ultrasound L37636 LCD and added to this article. Under Covered ICD-10 Codes Group 1: Codes added R93.5.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L37636 - Nonobstetric Pelvic Ultrasound
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/22/2024 10/01/2023 - 04/22/2024 Retired You are here
08/10/2023 10/01/2023 - N/A Superseded View
08/24/2022 10/01/2022 - 09/30/2023 Superseded View
08/16/2022 10/01/2022 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Ultrasound
  • Pelvic Ultrasound
  • Nonobstetric Pelvic Ultrasound