Ob-Gyn Coding Alert

If you think that all of your practice's obstetric ultrasounds are "detailed," take note: CPT 2003 specifies which anatomic evaluation elements you must document when billing 76811 and 76812.

The new introduction to CPT's Obstetrical Ultrasound section advises you to report the new detailed ultrasound codes only if you evaluate all of the standard ultrasound elements, plus several additional anatomical components.

"Our standard ob ultrasound includes head and abdomen circumference measurements, femur length, amniotic fluid and placenta assessment, four-chamber heart and three-vessel cord evaluations, cardiac and limb movement evaluations, and cervix length measurement," says Carrie Caldewey, RCC, CPC, office manager at Redwood Regional Medical Group in Santa Rosa, Calif. "Adetailed examination would include all of those factors, plus ventricle examination, specific organ aspects, information regarding limb or spine formation, and other information. The detailed instructions in CPT are fairly clear on how the two differ." Case #1: Detailed Ultrasound for History of Birth Defects A 28-year-old patient presents for an initial obstetrical abdominal ultrasound at 18 weeks. Because her first child was born with cardiac birth defects, the ob-gyn performs a detailed ultrasound. The physician determines the patient is carrying twins, and examines the normal maternal and fetal structures, as well as cardiac outflow tracks, limb and spine formation and vascularization, and cerebral blood flow. The physician determines that both fetuses are healthy. For this visit, you would report 76811 for the detailed ultrasound of the first fetus and 76812 for the detailed scan of the second fetus. You should link the detailed ultrasound codes to 651.03 (Twin pregnancy; antepartum condition or complication) and V23.49 (Pregnancy with other poor obstetric history). Case #2: Ultrasounds Before and After Fetal Loss A 26-year-old patient presents for a transvaginal ultrasound because of abdominal pain. The physician determines that the patient is six weeks pregnant with two fetuses in separate gestational sacs. The patient suffers from vaginal bleeding at week 15 and returns to the practice. A transabdominal ultrasound reveals that the patient lost one fetus. The practice performs a detailed anatomic examination of the remaining fetus, and the physician declares it healthy.

"For the initial visit, we would use American College of Radiology (ACR) guidelines (ACR's Ultrasound Coding User's Guide) to determine whether to use the standard transvaginal ultrasound code (76830) or an obstetrical transvaginal ultrasound code (76817)," Caldewey says. "The ACR dictates that a patient with an unconfirmed pregnancy even if pregnancy is later determined during the ultrasound warrants 76830. In this case, it sounds as though the patient was not aware that she was pregnant, so I would report 76830." Note: Not all payers follow the ACR guidelines, so [...]