Radiology Coding Alert

If your practice believes that all of your obstetric ultrasounds are "detailed," take note: CPT Codes 2003 specifies which anatomic evaluation elements you must document when billing 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation) and +76812 ( each additional gestation [list separately in addition to code for primary procedure]).

The new introduction to CPT's Obstetrical Ultrasound section advises physicians to report the new detailed ultrasound codes only if they evaluate all the standard ultrasound elements, plus several additional anatomic components.

"Our standard ob ultrasound includes head and abdomen circumference measurements, femur length, amniotic fluid and placenta assessment, four-chamber heart and three-vessel cord evaluations, cardiac and limb movement evaluations, and cervix length measurement," says Carrie Caldewey, RCC, CPC, office manager at Redwood Regional Medical Group in Santa Rosa, Calif.

"A detailed examination would include all of those factors, plus ventricle examination, specific organ aspects, information regarding limb or spine formation, and other information. The detailed instructions in CPT are fairly clear on how the two differ."

CPT 2003 also offers new postdescriptor advice, guiding coders to the appropriate add-on codes and modifiers. For instance, previous CPT editions instructed coders to use modifier -51 (Multiple procedures) for second and third fetal biophysical profiles (BPP, 76818-76819). This year, CPT recommends appending modifier -59 (Distinct procedural service) instead.

"Coders should also note that CPT 2003 explicitly states that if the practice performs a transvaginal examination in addition to a transabdominal nonobstetrical ultrasound exam, report 76830 (Ultrasound, transvaginal) in addition to the transab-dominal exam code (76856-76857)," says Melanie Witt, RN, CPC, MA, an independent coding consultant and educator in Fredericksburg, Va. "You will still have to append modifier -51 in all likelihood to the second scan."

CPT also revised existing codes to specify single gestations versus "each additional" gestation, fetal age, and transvaginal versus transabdominal approach. The following case studies should help physicians select the correct ultrasound code: Case Study #1: Ultrasounds Before and After Fetal Loss A 26-year-old patient presents for a transvaginal ultrasound. The physician determines that the patient is six weeks pregnant with two fetuses in separate gestational sacs. The patient suffers from vaginal bleeding at week 15 and returns to the practice. A transabdominal ultrasound reveals that the patient lost one fetus. The practice performs a detailed anatomic examination of the remaining fetus, and the physician declares it healthy. "For the initial visit, we would use American College of Radiology (ACR) guidelines to determine whether to use the standard transvaginal ultrasound [...]