# OB Ultrasounds - Transabdominal and Transvaginal



## jen11976 (Aug 27, 2010)

I have a provider billing for a Transabdominal (76801), Transvaginal (76817) and Fetal Nuchal Translucency (76813).  Does anyone know what documentation is needed for the 76801 and 76817?  Are 2 separate reports needed?


----------



## preserene (Aug 27, 2010)

Justifying TVUS over TAUS at early Second Trimester:

Yes, it should be accompanied with a report, because  at this period time pregnancy we have to substantiate the merits of TVUS over the TAUS.
But a single Report (special report) with pertinent informations as to why it was done over and above the TAUS would be necessary. but the images and interpretation obviously should be different.

Here is a clip to justify why Transvaginal US also would be needed to do over and above the Trans abdominal US .
  Usually Vaginal ultrasound is used for very early pregnancy to bring out more vivid picture and structures of fetal and maternal perspectives.
Sometimes for heavier women with more abdominal fat, it is very useful in getting a clearer picture to determine whether there is an ectopic pregnancy, whether the fetus is viable, if there are multiple fetuses, etc.  It is especially useful in heavyset women and perhaps, in women with a retrograde uterus. The closeness of the trans-vaginal transducer (and its ability to use somewhat higher frequencies) is a particular advantage in the case of very heavy women with extensive abdominal adiposity.  Although abdominal ultrasounds definitely work on heavy women later on in pregnancy, sometimes, they are not very effective earlier in pregnancy.  
Thus transvaginal ultrasounds are especially common in women of size early in pregnancy and at this point. However, it is also not unusual for women of all sizes (not just heavy women) to have difficulty getting a clear abdominal ultrasound at this time of pregnancy, although around the end of the first trimester, most average-sized women can have an abdominal ultrasound done. However, every woman is different and many larger women have reported being able to use an abdominal ultrasound at about that time too. *Each case will be different and has to be decided at the time, *but be aware that transvaginal ultrasounds may have to be used just a bit longer in larger women. extensive adiposity can sometimes make it harder to see everything thoroughly. 
The area that tends to be most difficult to see in big women is the baby's heart, and sometimes the baby's spine, the mother's ovaries, and the baby's kidneys or urinary system as well.  *Please note that most of the time, these are seen without problem in women of size, but that sometimes a repeat scan may need to be done. So instead of waiting  for yet another round of US, certain of the anotpmy can be captured by Transvaginal at this session it self.*
More importantly, it is more often  needed to get a more  clear picture about the*” low lying placenta”* at 2nd trimester trans vaginal  Us than trans abdominal,  though its position gets to a higher level sometimes, depending upon the degree of lowness of the placenta and so early detection of lowlying placenta for treatment and councelling  purposes
are mandatory.
Thank you.


----------

