Ob-Gyn Coding Alert

Question: Patient with an unknown last menstrual period (LMP) came in for confirmation of pregnancy and had an ultrasound(US). By US, she was 16/2weeks. Measurements were done;fetal heart tones (FHTs) as well as looked at the baby’s heart. Which US code would be best for this?What about 76815?

California Subscriber

Answer: Code 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)does not include fetal measurements, so this would not be correct. However, 76805(Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester [> or = 14 weeks 0 days], transabdominal approach; single or first gestation) would require all of those items to be performed as defined in CPT®.

In other words, you may have not performed all of the requirements for 76805, but you performed something more than 76815. You may have met the criteria for 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) even though this was later than 14 weeks.