Ob-Gyn Coding Alert

Ob/gyn patients undergo ultrasounds for a number of reasons. A physician likely will perform at least one ultrasound during the course of normal global ob care and could order one for the non-ob patient with a gynecological complaint. Because of the small variety of closely related ultrasound codes, successful billing for more than one ultrasound depends on the diagnosis and documentation. Ultrasounds in Pregnancy Between 45 percent and 70 percent of women have an ultrasound sometime during their pregnancy, usually at 18-20 weeks' gestation. In fact, the American College of Obstetricians and Gynecologists (ACOG) maintains that one complete ultrasound be included as a routine part of obstetric care. Most carriers will allow one complete obstetrical ultrasound per pregnancy, either as part of the global package or as a separately billable item. Obviously, the optimal plan for providers is to have that ultrasound be billable separately. "Many providers are including an ultrasound as a standard part of the global package for pregnancy," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C. "Unless outlined in your carrier contract as a separate service, it's unlikely that it will be billable separately."

The most commonly used ultrasound code is 76805 (Ultrasound, pregnant uterus, B-scan and/or real time with image documentation; complete [complete fetal and maternal evaluation]). The test reveals viability, the number of fetuses, fetal position, amniotic fluid volume, fetal measurements, placental location and fetal weight estimation and allows basic anatomical review. The complete ultrasound also "troubleshoots" for problems such as malformations, poor weight gain and breech presentation. "We typically use the complete ultrasound for dating parameters, due to inconsistencies with the patient's last menstrual period and their size," says Charline Wells, coding and compliance auditor with Valley Obstetrics & Gynecology in Spokane, Wash. Wells says that the complete ultrasound also is used for viability checks when the patient has a threatened miscarriage or has a history of habitual miscarriages, and position checks for possible breech presentation. Apart from 76805, which can be used as a routine screening tool during pregnancy, the other pregnancy-related ultrasounds (76810-76828) generally are reserved for high-risk or problem pregnancies. If a pregnant patient presents with problems that indicate she may be high-risk, or if a routine ultrasound indicates risk or a problem that may need to be followed, the ob/gyn may decide to schedule more than one ultrasound during the pregnancy, perform one or more amniocenteses, or even perform multiple ultrasonic procedures during the same visit.

For instance, if, at 18 weeks, a 35-year-old patient presents for a routine ultrasound (76805), yet it indicates a possible fetal anomaly (655.13, Chromosomal abnormality in fetus; antepartum condition or complication), the physician may perform an [...]