Ob-Gyn Coding Alert

Question: My ob-gyn practice has a new ultrasound machine, and I need help with how to bill for this service in office. The only ultrasounds we do are for early in pregnancy to confirm viability. On rare occasions, we may use it to look for an intrauterine device (IUD) placement. What does my ob-gyn need to document in order for me to bill for this service? Also, can I bill this service under a midwife? North Dakota Subscriber

Answer: An ultrasound to check for fetal viability usually means  the ob-gyn is looking for a fetal heart beat. That would be76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], one or more fetuses). If the ob-gyn does more than that, you might qualify 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) if the gestation is less than 14 weeks or 76805 (... after first trimester [> or = 14 weeks 0 days] ...) if greater. IUD placement checks can be 76830 (Ultrasound, transvaginal) or 76857 (Ultrasound, pelvic [nonobstetric], real time with image documentation; limited or follow-up [e.g., for follicles]), but again, you have to go by what was documented. CPT guidelines tell you what you have to document for each of these codes. In order to get paid, the ob-gyn must interpret the result by writing in the medical record the findings and what it means for the patient/pregnancy.

If the midwife is billing, it is the midwife who does the interpretation (assuming he/she is allowed to do the interpretation under the State Practice Act). If you own the machine, you should not be billing under the certified nurse midwife (CNM) number if the ob-gyn did the interpretation.