Ob-Gyn Coding Alert

Question: We reviewed the Ob-Gyn Coding Alert Vol. 10, No. 12 and have a question regarding the ultrasounds article. On page 87, the "Scenario" section states, "During a level-one exam, the ob-gyn suspects that the patient has a fetal anomaly and orders a detailed/targeted ultrasound. In this case, you would use 76811."-The article's last sentence under "Focus on 2 Differences" states, "You-ll report 76811 for a specific reason (such as suspected fetal anomaly) and should consider it a second-level ultrasound that technicians perform on high-resolution special ultrasound equipment." It seems to contradict where (ob-gyn office setting/perinatalogist) one can use 76811.

Rhode Island Subscriber

Answer: In scenario one, the ob-gyn first orders a basic exam. Based on what he sees at that time, he decides to go further and do a detailed scan.-

You cannot bill 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 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation) together. Code 76805 is a component of 76811.

End result: You should bill only 76811 with a diagnosis for the problem.-

Get this straight: Some practices have purchased the more advanced machines and therefore have the capability to do the detailed scans.-However, owning the advanced machine doesn't automatically mean you-ll report for this level of exam when you don't have medical necessity to support it. Remember: A detailed scan is never appropriate as a screening exam.-

To reiterate, a detailed exam should be:

1. medically indicated and not a screening exam, and

2. performed using an ultrasound machine capable of producing detailed images, and

3. interpreted/performed by a physician with advanced training and expertise.