# Anatomy Scan



## scurtis7189 (Jun 6, 2014)

When billing for a 20 week/anatomy ultrasound...

Is this the correct coding? : 
CPT code 76811 with ICD-9 code v28.81

One of the physicians I work with has been using 76805 with all of the detailed anatomy notes, while the other physicians use 76811. Which is correct?

Thank you!


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## mzkandyd (Jun 6, 2014)

Yes, use 76811 and V28.81.


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## dcrossman (Jun 23, 2014)

I sorta disagree.  Our office uses 76805 for our routine 20 week sonograms.  The reason being is: just because you can look, doesn't mean it was medically necessary.  

76805 includes: determination of gestational sacs and fetuses; evaluation of amniotic fluid, four chambered heart, intracranial, spinal, abdominal anatomy; placental location; umbilical cord insertion site; examination of maternal adnexa if visible.

76811 includes: determination of gestational sacs and fetuses; evaluation of amniotic fluid; chest anatomy; face, fetal brain/ventricles; four chambered heart; heart/outflow tracts and chest anatomy; limbs including number, length, and architecture; other fetal anatomy as indicated; placental location; umbilical cord insertion site, examination of maternal adnexa if visible, written documentation of each component of exam including reason for nonvisualization when applicable.  

For us: we do 76805, and should we find something suspect, we then will move on the 76811. We do look at limbs, face, heart, brain, etc. but just because we looked doesn't mean we automatically pick 76811. I don't know if we are right or wrong, but I tend to err on the side of caution.  Unless we have an indication, we tend to go with the lesser of the two, because truthfully we are looking for fetal and maternal evaluation, and then should we find a reason to go more in depth we will do so.  

Again, I don't know which is better.


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## sarahjanejones (Jun 23, 2014)

I most often see the use of 76805 for the 20 week ultrasounds.


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## scurtis7189 (Jul 15, 2014)

Thank you all for your input. I researched this a bit more, and found some documentation. It states that 76811 should only be used if done by a MFM specialist. There was quite a bit of other helpful notes and information.
Here is the link, I found it useful.
http://www.medsolutions.com/documen...OBSTETRICAL ULTRASOUND IMAGING GUIDELINES.pdf


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## mgutierrez@rpmhd.org (Sep 1, 2014)

Thanks for posting the Med Solution guidelines, they are very helpful!


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