Ob-Gyn Coding Alert

Question: We have been billing multiple gestation ultrasounds with code 76810 twice for the same date of service for the past four years and have consistently received reimbursement from the insurance companies. Recently our practice was bought by a medical center whose billing office feels we are billing these ultrasounds incorrectly. We have agreed to pose the question to OCA. Who is right?

Pam Cousino, Billing Assistant
Northwest Ohio Ob/Gyn Associates, Toledo, OH

Answer: The code 76810 (complete echography of pregnant uterus for multiple gestation) has a higher relative value than 76805 (complete echography of pregnant uterus when there is only one fetus) to account for the additional work involved in evaluating more than one fetus (3.64 RVUs versus 7.23 RVUs). Therefore, the quantity will always be one when 76810 is billed. The medical center billing office is correct, and although the payer may have reimbursed you for both ultrasounds on the same date, they should not have if the CPT definition of the code is applied.