Transvaginal Pelvic Ultrasound (not pregnancy)

What it is

Ultrasound images are made from sound echoes, and sound loses detail as it travels through tissue. Scanning through the abdominal wall means pushing sound through skin, fat, and muscle before it reaches the uterus. A transvaginal probe skips all of that: it is a narrow transducer, covered and lubricated, placed a couple of inches into the vagina so that it sits right beside the organs being imaged. The result is a much sharper picture of the lining of the uterus, the ovaries, and small structures within them. The "non-obstetric" part of this code means it is not being used to assess a pregnancy — the same technique used in pregnancy is coded and priced differently.

Why it is done

• To look into abnormal or unexplained vaginal bleeding, including bleeding after menopause
• To examine the ovaries for cysts or masses, and to characterize something already found
• To look for fibroids and to measure the thickness of the uterine lining
• To investigate pelvic pain, or to follow the ovaries during fertility treatment
• To check the position of an intrauterine device

What to expect

Unlike a scan through the abdomen, this one is usually done with the bladder empty, so patients are asked to use the bathroom first. The exam resembles a pelvic examination: undressing from the waist down, lying back with the knees bent and supported, and the probe being inserted gently by the sonographer or physician. It is generally more comfortable than a manual gynecologic exam, though pressure is felt as the probe is angled to see different structures, and it can be tender when the pain being investigated is in the pelvis. It usually takes under half an hour, and normal activity resumes immediately. A chaperone can be requested.

Questions worth asking

• Was a scan through the abdomen done as well? The two approaches are often performed in the same visit and can be billed as two separate exams.
• Is this being done in a gynecologist's office or in a hospital imaging department? The office scan usually avoids a hospital facility fee.
• If a Doppler assessment of blood flow was added, is that a separate charge?
• Who reads the images — the gynecologist performing the scan or an outside radiologist — and will that reading be billed on its own?