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Radiology Coding Alert

New 2003 Ultrasound Codes Get Detailed

Published on Fri Nov 01, 2002

Changes to CPT codes for 2003 are going to have a big impact on radiology coders. Ground-shakers include new ultrasounds and codes for removing pericatheter obstructive material, but unknown RVU rates mean the temblors aren't over with yet.

Although numerous wording changes and introductory notes affect how present codes are applied, a number of new codes are equally noteworthy especially for pregnancy ultrasounds, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based firm.

It's Quintuplets for Pregnancy Ultrasound

CPT Codes 2003 makes significant wording changes to four existing ultrasound codes and adds five new ultrasound codes for a pregnant uterus. The new codes and verbiage changes require coders to discriminate according to whether the fetus is at more or less than 14 weeks of gestation, Parman says. This development spells RVU relief to radiologists and ob-gyns because more physician effort is necessary to obtain an image as the pregnancy advances. The new transabdominal US codes include:

  • CPT 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (<14 weeks 0 days), transabdominal approach; single or first gestation

  • +76802 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (<14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)

  • 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

  • +76812 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transab-dominal approach; each additional gestation (list separately in addition to code for primary procedure).

    It's a little different model than we're used to, says Robert L. Bree, MD, member of the Society of Radiologists in Ultrasound and the AMA CPT Advisory Committee. A potential storm on the horizon may start brewing since many doctors already do the detailed exam regularly (because everybody is at risk for an abnormality in one way or another). Physicians may reason, "If we do the detailed exam anyway, why not be paid what we think is appropriate?" So, if payers see their ob ultrasound costs undergo a dramatic increase they may start disallowing the codes, Bree predicts.

    The bumper crop of add-on codes for multiple gestations, which will appropriately reimburse ob-gyns and radiologists for the extra work they perform to monitor and assess additional gestations, is another welcome addition, Parman says.

    Because the expanded introductory notes in CPT 2003 for obstetrical ultrasounds detail both documentation requirements and acceptable code combinations, Parman advises coders to memorize them.

    Part of the fun, she says, will be providing the increased documentation that is now a definitional part of the code. The new codes all specify a "detailed fetal anatomic examination," while the code revisions (see below) describe "limited" exams and give examples of exactly what must be included in the medical record:

  • 76815 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

  • 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., reevaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system[s] suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus.

    Other revised text includes 76805, which signifies a single or first gestation at 14 weeks or less, and +76810, which is for each additional gestation and is listed separately in addition to the code for the primary procedure.

    In the ultrasound revolution, coders will have a new transvaginal pregnancy code, 76817, Ultrasound, pregnant uterus, real time with image documentation, transvaginal. 76817 is significant because until now, Bree says, most people didn't use a transvaginal code with ob-gyn ultrasounds. "They would just bundle it into the transab-dominal code." Now, 76817 gives coders a clear solution by allowing them to add the procedure when it's actually done. Since this is a mostly non-Medicare issue, other payers will have to decide whether they're going to pay it, Bree says.

    One other helpful change occurred with 76816 (Ultrasound, pregnant uterus, real time with image documentation ...). The description of "follow-up" now lists specifics with regard to re-evaluation of the organ systems "suspected or confirmed to be abnormal on a previous scan."

    This code also contains a parenthetical note to use modifier -59 (Distinct procedural service) for each additional fetus examined in a multiple pregnancy. "We're finally getting some guidance on when modifier -59 is appropriate according to the AMA," Parman says.

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