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Primary Care Coding Alert

READER QUESTIONS :

Be Aware of Surroundings on US Claims

Published on Thu May 21, 2009

Question: The FP meets a 27-year-old patient who is 16 weeks pregnant at the local hospital after an accident at her workplace. She fell down the stairs and reports pain in her twisted left ankle. The FP performs a level-three E/M in the hospital outpatient unit, during which she diagnoses and wraps a sprained left internal collateral ligament; then, she performs obstetrical ultrasound (US). After examining the US, the physician determines that the fetus has not sustained any injury. Do I need a modifier for the US? Georgia Subscriber Answer: Since you are using the facilitys equipment, youll need a modifier for the US. On the claim, report the following: " 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) for the US " modifier 26 (Professional component) appended to [...]
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