# Ultrasounds - gyne vs OB



## poekar (Feb 6, 2017)

When a patient is being evaluated for a  Miscarriage or Complete AB - Is there a rule about what kind of Ultrasound coding to use?  A gyne ultrasound vs and OB ultrasound?  For an incomplete AB - I am using OB Ultrasound codes.
I believe you should use the OB ultrasound codes for both of these instances - because it is evaluating a pregnancy outcome - but I can't find anything in writing.
My doctors code the gyne ultrasound codes in these instances and I think that is incorrect.

Thank you very much for your help.  Karen


----------



## tracylc10 (Feb 8, 2017)

It is appropriate to code an obstetrical ultrasound for a patient who has an established diagnosis of pregnancy, who presents with indications necessitating the exam that may be pregnancy related, even when the outcome shows that the patient is no longer currently pregnant.

I found this in OPTUM Coding Companion Obstetrics/Gynecology.


----------



## kathyvl74 (Feb 9, 2017)

Yes, I agree with Tracy. Once the pregnancy has been established, the OB ultrasound codes are used.


----------



## susiloving11 (Feb 20, 2018)

What if the patient has a positive pregnancy test but the trans abdominal ultrasound does not show a pregnancy in the uterus?  Which U/S code would you use? 
Thanks in advance,
Susie Loving, CPC


----------



## asehr (Feb 27, 2018)

I took a webinar which stated to use OB codes only if a fetal pole was seen. Is that not correct information? Can someone clarify?


----------



## elalewine@gmail.com (Apr 19, 2022)

I found this information from AAPC’s website https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/you-be-the-coder-transvaginal-pelvic-ultrasound-article :

Published on Sun Oct 01, 2000
*Question**:* 
_If a transvaginal pelvic ultrasound is performed and an intrauterine pregnancy is found, assuming evaluation of the gestational sac, pole and adnexa were performed, is it proper to code it as a complete obstetrical or a transvaginal pelvic ultrasound? What if an ectopic pregnancy is found?_

*Answer**:* 
According to the American College of Obstetrics and Gynecologys (ACOG) coding manual (_Ob/Gyn Coding Manual: Components of Correct Procedural Coding,_ page 305), a transvaginal ultrasound involves looking at the uterus, tubes, ovaries and pelvic structures, as indicated. This code does not provide whether the ultrasound can be performed only on a non-pregnant woman, so you are free to use 76830 (echography, transvaginal) if you like.

Code 76805 (_echography, pregnant uterus, B-scan and/or real time with image documentation; complete [complete fetal and maternal evaluation]_), on the other hand, more specifically describes the service your physician may have performed. Here again, the ACOG coding manual states that this ultrasound includes visualization using transabdominal or transvaginal transducer of maternal structures including uterus, cervix and adnexae and visualization of fetal structures including fetal anatomy, fetal number, presentation, biometric parameters, placenta, amniotic fluid volume, cardiac activity and movement appropriate for gestational age. If this is what was documented by the physician for the intrauterine pregnancy, 76805 would be the correct code to use.

If the work was less than described above, you have the option of adding modifier -52 (_reduced services_) to 76805. Note that 76805 has more RVUs (3.67) under the Medicare fee schedule than 76830, which has 2.62 RVUs. So the complete ob ultrasound is more complex. *When an ectopic pregnancy is confirmed, *_*you should use 76830 instead*_*, as *_*you cannot meet the definition for a complete ob ultrasound*_*.*


_Source for You Be the Coder is *Melanie Witt, RN, CPC, MA,* the former program manager for the American College of Obstetrics and Gynecology (ACOG) department of coding and nomenclature and an independent coding educator._

I hope this helps! ~ Eileen


----------



## nielynco (Apr 19, 2022)

tracylc10 said:


> It is appropriate to code an obstetrical ultrasound for a patient who has an established diagnosis of pregnancy, who presents with indications necessitating the exam that may be pregnancy related, even when the outcome shows that the patient is no longer currently pregnant.
> 
> I found this in OPTUM Coding Companion Obstetrics/Gynecology.


Quite right Tracy.  In fact, the AMA CPT Assistant had an article a few years back (about an ultrasound performed in the ER) that supports this.  You code the ultrasound type based on what the provider is looking for.  If he/she is suspecting pregnancy, then an ob ultrasound would be coded, even if the result was no pregnancy.  Likewise, if he/she suspected an ovarian cyst and a pregnancy was found, a gyn ultrasound is coded instead.


----------



## elalewine@gmail.com (Apr 21, 2022)

nielynco said:


> Quite right Tracy.  In fact, the AMA CPT Assistant had an article a few years back (about an ultrasound performed in the ER) that supports this.  You code the ultrasound type based on what the provider is looking for.  If he/she is suspecting pregnancy, then an ob ultrasound would be coded, even if the result was no pregnancy.  Likewise, if he/she suspected an ovarian cyst and a pregnancy was found, a gyn ultrasound is coded instead.



Thank you, Nielynco - I had actually been researching and putting together some information I located for our coding team, regarding OB Diagnostic Ultrasounds - and I totally misunderstood my initial reference I posted just a few days ago - meaning that if the ectopic pregnancy is 'discovered' during the transvaginal and no follow-up is ordered, than a Non-OB would be reported.  

Nielynco - what is a fetus is not identified (as in an ectopic pregnancy) and the facility reports a Non-OB transvaginal, followed by OB transvaginal, following HCG positive (tub ligation)?  I know that CCI edit prevents Non-OB with OB, even with a modifier. So, obviously with the initial transvaginal, there is not a 'review/report' on the components needed for the OB transvaginal 76817.  Thank you, in advance, for any assistance. 



*Report codes 76801 and 76802 only during the first trimester of pregnancy (less than 14weeks.)*​​Code *76801* and *76802* include *determination of the number of gestational sacs and fetuses*, *gestational sac/fetal measurements appropriate for gestation*, *survey of visible fetal and placental anatomic structure*, *qualitative assessment of amniotic fluid volume/gestational sac shape*, and *examination of the maternal uterus and adnexa*.​​Report code *76802* in addition to code *76801* for each additional fetus studied when there are multiple fetuses.​​*If a patient is clinically pregnant (positive HCG) and the gestational sac and fetus cannot be identified as long as they have been sought, code 76801 can be reported. If these elements aren’t mentioned, it is a limited study reported with code 76815.*​​Report code *76805* for routine OB ultrasound after the first trimester of pregnancy. Report addon code *76810* for each additional gestation.​​Codes *76805* and *76810* include determination of number of fetuses and amniotic/chorionic sacs, measurements appropriate for gestational age, survey of intracranial/spinal/abdominal anatomy, four-chambered heart, umbilical cord insertion site, placenta location and amniotic fluid assessment, and (when visible) examination of maternal uterus and adnexa. The maternal adnexa must be mentioned in the report.​​Report code *76810* in addition to code 76805 for each additional fetus studied when there are multiple fetuses.​​*If non-obstetrical ultrasound is ordered and a fetus is identified,** it should be reported as a non-obstetrical study* (*76856* or *76857*) *unless* a *complete OB ultrasound is subsequently requested*.​​Report code *76811* for an extensive ultrasound exam performed for a pregnancy when there is a high risk of fetal birth defects. Report add-on code *76812* for each additional gestation.​​Codes *76811* and *76812* include all elements of codes *76805* and *76810* plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs, and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated. There must be documentation of the medical necessity for performing this detailed study. There must be reason to suspect there could be a congenital anomaly.​​Report code *76812* in addition to code *76811* for each additional fetus studied when there are multiple fetuses.​​Do code nuchal translucency (*76813*) in addition to complete or limited first trimester OB ultrasound when both are performed. Report add-on code *76814* for each additional gestation. Nuchal translucency includes a detailed evaluation of the soft tissues of the posterior aspect of the fetal neck, which is *not* part of the OB ultrasound. This test should be performed during the 11th to 14th weeks of gestation.​​Report add-on code *76814* in addition to *76813* for nuchal translucency studies performed on additional fetuses.​​Codes *76813* and *76814* can be performed transabdominally or transvaginally.​​Code *76815* represents a focused quick look exam limited to the assessment of one or more of the elements listed in codes *76801*-*76812*.​​*Report* code *76815* when *all* the required elements in codes *76801*-*76812* are *not documented* in the physician report.​​*Do not use code 76815 more than once during an encounter*, as it includes imaging of multiple fetuses and multiple elements.​​Report code *76816* if the ultrasound exam is a *reassessment of an abnormality discovered on a previous ultrasound exam*. *Code 76816 is also used to report the re-evaluation of fetal anatomy not visualized well on a previous study*.​​Code *76816* describes an *examination designed to reassess fetal size and interval growth or re-evaluate one or more anatomic abnormalities of a fetus previously demonstrated on ultrasound*. It should be coded once for each fetus requiring reevaluation using a distinct procedure modifier for each additional examined fetus.​​Code *76817* describes a transvaginal obstetric ultrasound performed separately or in addition to one of the transabdominal examinations described above. It should include evaluation of the uterus, endometrium, ovaries, and adnexa. When both are reported, best practice is they should be in separate reports or separate sections of a report.​​Report code *76817* one time, no matter how many fetuses are involved.​​Do not use code *76817* for non-obstetric transvaginal ultrasound. Report code *76830*, Ultrasound, transvaginal.​​*Report OB ultrasound codes for any study that begins as pregnancy-related (patient has been verified as pregnant) even if the final diagnosis is non-pregnancy related*_._​
*References:*

ACR, Online Guide to Ultrasound Coding, FAQs, 2012
ACR, Ultrasound Coding User’s Guide
ACR Radiology Coding Source, Volume 62, Issue 7, July-August 2007
Baby Center, Nuchal Translucency (NT) Scan, 2014
Clinical Examples in Radiology, Winter 05:3, Winter 07:6, Summer 10:9, Summer 11:10, Summer 12:11, Winter 15:8-9, Winter 16:13, Spring 19:9-11, Winter 20:13, Summer 20:10, Spring 20:13, Winter 20:12
Coding Clinic for HCPCS, Third Quarter 10:7
CPT Assistant, Dec 01:6, Mar 03:7, Nov 03:14, Nov 04:10, Nov 05:15, Dec 05:3, May 10:9, Nov 11:10, Jul 16:9
 CPT Changes: An Insider’s View 2003


----------

