Ob-Gyn Coding Alert

Question: Our Maternal Fetal Medicine (MFM) office wants to charge a 93976 to check the uterine artery. Is it appropriate to bill the 93976 for this, and should this be done only during a certain trimester? Typically it is being done for one of the following conditions: Chronic HTN, Hx of Pre-eclampsia, Recurrent pregnancy loss and Hx of fetal demise. What should we do?

Nevada Subscriber

Answer: The code you have suggested, 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study), is for the evaluation of the arteries and veins in an organ. You should never code this for uterine artery velocimetry.

Currently, you only have two codes for velocimetry: 76820 (Doppler velocimetry, fetal; umbilical artery) and 76821 (… middle cerebral artery), but each describes only the umbilical or middle cerebral arteries.

Several years ago, American Congress of Obstetricians and Gynecologists (ACOG) suggested that the code 76828 was probably the closest code. However, the physician is not analyzing the fetal heart, so this may still not pass muster with the patient’s payer. Also, according to CPT^®, you do not pick the closest code; you pick the accurate code.

Under those guidelines, this would be an unlisted procedure (76999, Unlisted ultrasound procedure [eg, diagnostic, interventional]) and compare the work 76828 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study).

Also, understand the uterine artery velocimetry is considered investigational by many of the larger commercial payers, so make sure the patient is made aware of this.