Diagnosis: ovarian cyst.
Treatment: CPT 76376 - 3 Dimensional (3D) Pictures (Pelvic Imaging).
The insurer denied CPT 76376 - 3 Dimensional (3D) Pictures (Pelvic Imaging).
The health plan's determination is upheld.

CPT 76376 - 3 Dimensional (3D) Pictures (Pelvic Imaging) provided at the beginning of the year is not medically necessary for this patient.
The three-dimensional ultrasound imaging of the pelvis is not medically necessary in this case. The purpose of sonography of an ovarian cyst is to assess whether a lesion is growing or resolving, and whether the abnormality raises concern for malignancy. These results would then be used to assess the need for surgery. There are numerous guides and calculators to help a clinician decide where surgery is needed for an ovarian cyst. None of these involve 3D imaging. Simple 2D measurements are the basis for assessment of ovarian cysts, and therefore 3D imaging is not necessary. One can obtain the necessary information to make a decision about surgery from a standard 2D ultrasound. Therefore, the 3D rendered ultrasound (CPT 76376) is not medically necessary.