Ob-Gyn Coding Alert

Question: A patient came into the clinic for a routine prenatal visit, and we performed an ultrasound for fetal position. The equipment belongs to the clinic. Should I use modifier 25 on this visit and code 76815 for the ultrasound?

Massachusetts Subscriber

Answer: Your question does not make it clear whether you are entitled to bill for both the technical and professional component for the ultrasound, nor whether you are billing each antepartum visit separately.

When billing each antepartum visit separately, you will use the code designated for this purpose by your payer (E/M problem code [99201-99215] or some other code, such as 59425, Antepartum care only; 4-6 visits).

Most payers do not require modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service when you bill one with a diagnostic lab or radiology procedure, but some do. Best bet: Make sure you ask your carriers about this before submitting the claim.

You will bill the ultrasound as 76815-26 (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; professional component) if your physician is only billing for the professional component. You must have a written report and image documentation. If the ob-gyn does this procedure with a handheld device with no image produced, you cannot bill for this service at all.

If you-re billing globally, you should not report the visit. You should only report the ultrasound (76815-26).