Ob-Gyn Coding Alert
If Your Ob-Gyn Merely Reviews Ultrasound, Find Out If You Can Use Mod 26
Question: Patient had 76815(Ultrasound, pregnant uterus, real time with image documentation, limited [eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], 1 or more fetuses) and 76819 (Fetal biophysical profile; without non-stress testing) done on 1/5/15 (with breech presentation) as well as 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) and 76700(Ultrasound, abdominal, real time with image documentation; complete) (due to flank pain, with cephalic presentation) on 1/20/15 (both performed in the hospital). I’ve read in the archives that the doctor would need to interpret the report and write a formal report in order to bill for professional component (modifier 26). If our doctor merely reviews, then I’m assuming nothing can be billed?
Texas Subscriber
Answer: Correct. A review would constitute medical decision-making, not the professional interpretation and written report.
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