Ob-Gyn Coding Alert

If you're providing more than one ultrasound per obstetric patient - even during the same visit - make sure you're coding for them. Otherwise, you could be undercutting your practice's bottom line.
 
As much as 70 percent of women in the United States undergo a routine ultrasound evaluation during their pregnancies, usually at 18-20 weeks' gestation. In fact, the American College of Obstetricians and Gynecologists (ACOG) maintains that one complete ultrasound should be included as a part of routine obstetric care. Keep Ultrasounds Out of the Global Although many insurance providers include ultrasound as a standard part of the ob global package (for example, 59400, Routine obstetric care including antepartum care, vaginal delivery [with or with episiotomy, and/or forceps] and postpartum care), CPT maintains otherwise. "Antepartum care includes the initial and subsequent history, physical examinations, recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery," CPT states. "Any other visits or services within this time period should be coded separately."
 
In addition, the AMA has stated that the ob global package does not include diagnostic ultrasound, according to the April 1997 CPT Assistant. Code Those Ob Ultrasounds Generally, physicians use obstetric ultrasounds (for example, 76801, Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester [<14 weeks 0 days], transabdominal approach; single or first gestation) to show viability, the number of fetuses, fetal position, amniotic fluid volume, fetal measurements, placental location, and fetal weight estimation and allow basic anatomical review.
 
Doctors often use these ultrasounds as more precise dating tools to better determine delivery dates. Or the ob-gyn can use them to check viability when the patient has a threatened miscarriage or has a history of
habitual miscarriages.
 
For a more detailed fetal view using ultrasound, you would report 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation) or +76812 (... each additional gestation [list separately in addition to code for primary procedure]), says Jaime Darling, CPC, a certified coder for Graybill Medical Group in Escondido, Calif. These ultrasounds allow the ob-gyn to take more detailed measurements and assess any malformations. Multiple Ultrasounds Mean Multiple Codes Apart from 76801 and 76805 (... after first trimester [> or = 14 weeks 0 days] ...), you generally will use the other pregnancy-related ultrasounds (76810-76828) for high-risk or problem pregnancies. If a patient presents with problems that indicate she may be high-risk or if a routine ultrasound indicates a problem that may need to be followed, the ob-gyn may decide to schedule more than one ultrasound during [...]