Ob-Gyn Coding Alert

Question: My ultrasound tech scanned a patient with a twin pregnancy. The patient is 31.5 weeks and the ultrasound done was an ob limited. Patient also had a biophysical profile (BPP) done. The visit was coded as follows:

• 76815-TC
• 76818-59
• 76818

Is this the coding correct?

North Carolina Subscriber

Answer: What elements were examined in doing 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], 1 or more fetuses)?

Code 76818 (Fetal biophysical profile; with non-stress testing) includes an ultrasound portion, which measures AFI, fetal movement, fetal tone, and fetal breathing.

The limited ultrasound would have to be for such things as placental position in order to bill for it separately. If that was the case, why are you billing only the technical component (modifier TC) for 76815 and no interpretation? You will likely not receive reimbursement for this.

Correct coding for the BPP for twins would be listed in this order:

• 76818,
• 76818-59 (Distinct procedural service)
• and you will need a diagnosis in addition to "twins" to establish medical need for the test.

This test measures fetal well being for cause (i.e., what did the MD suspect was wrong that warranted doing this diagnostic test?). A limited ultrasound would be billed on the third line of claim if the examination was for something other an AFI.