Ob-Gyn Coding Alert

Answer: According to the American College of Obstetrics and Gynecologys (ACOG) coding manual (Ob/Gyn Coding Manual: Components of Correct Procedural Coding, page 305), a transvaginal ultrasound involves looking at the uterus, tubes, ovaries and pelvic structures, as indicated. This code does not provide whether the ultrasound can be performed only on a non-pregnant woman, so you are free to use 76830 (echography, transvaginal) if you like.

Code 76805 (echography, pregnant uterus, B-scan and/or real time with image documentation; complete [complete fetal and maternal evaluation]), on the other hand, more specifically describes the service your physician may have performed. Here again, the ACOG coding manual states that this ultrasound includes visualization using transabdominal or transvaginal transducer of maternal structures including uterus, cervix and adnexae and visualization of fetal structures including fetal anatomy, fetal number, presentation, biometric parameters, placenta, amniotic fluid volume, cardiac activity and movement appropriate for gestational age. If this is what was documented by the physician for the intrauterine pregnancy, 76805 would be the correct code to use.

If the work was less than described above, you have the option of adding modifier -52 (reduced services) to 76805. Note that 76805 has more RVUs (3.67) under the Medicare fee schedule than 76830, which has 2.62 RVUs. So the complete ob ultrasound is more complex. When an ectopic pregnancy is confirmed, you should use 76830 instead, as you cannot meet the definition for a complete ob ultrasound.

Source for You Be the Coder is Melanie Witt, RN, CPC, MA, the former program manager for the American College of Obstetrics and Gynecology (ACOG) department of coding and nomenclature and an independent coding educator.