Ob-Gyn Coding Alert

An ob/gyn examining a high-risk ob patient or a patient whom he or she suspects to be high risk, may perform multiple procedures on a patient in one visit, including more than one ultrasound. Knowing the different ultrasound scenarios is the first step to clarifying and properly coding various ultrasound procedures.

For example, a physician suspects that an ob patient may have a fetal anomaly. The physician performs a complete sonogram (76805, echography, pregnant uterus, B-scan and/or real time with image documentation; complete [complete fetal and maternal evaluation]). After the sonogram, the physician recommends an amniocentesis (59000, amniocentesis, any method). The patient agrees to the amniocentesis, and the physician performs an amniocentesis with sonogram guidance, all at the same visit.

Billing for Multiple Ultrasounds

Some ob/gyn practices have difficulty getting reimbursed for multiple ultrasounds in one day. This raises the question of whether billing for more than one ultrasound is correct in the first place.

Angela D. Wood, CCS, CPC, a senior healthcare consultant with Elliott, Davis and Company, L.L.P., an Augusta, Ga., CPA firm that offers healthcare consulting to its medical clients, asks, Will Medicare and other insurers allow me to bill for two complete ultrasounds during the same pregnancy? And can I bill for both a 76805 and a 76816 (fetal biophysical profile) that take place on the same day?

The question of how much is too much in ultrasounds is less important than how you document what was done. I think what matters more is not how many times you bill 76805 but what was actually done a complex or a limited scan, which would be code 76815 (echography, pregnant uterus, B-scan and/or real time with image documentation; limited [fetal size, heart beat, placental location, fetal position, or emergency in the delivery room]),says Patricia Horvatich, office manager for Robyn M. Cook, MD, a solo practitioner in Kealakekua, Hawaii,

Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists (ACOG) department of coding and nomenclature and an independent coding educator, concurs with Horvatich. Witt also says that billing for both 76805 and the BPP (biophysical profile, 76818) at the same session is inappropriate. Unless you have a contract with your carrier that says you can bill more than one complete ultrasound in the pregnancy, then it is acceptable to do so. Practices should also bear in mind that with a complete ultrasound and a BPP on the same day, some payers are going to discount the second procedure.

Witt says that to justify the need for the second procedure, whether later in the pregnancy or at the time of the first ultrasound, there needs to be a separate [...]