Radiology Coding Alert

Question: A pregnant patient came in for an ultrasound(US). By US, she was 16/2weeks. Measurements were done; fetal heart tones (FHTs) as well as looked at the baby’s heart. Which US code would be best for this? Can we submit code 76815?

California Subscriber

Answer: You should not submit code 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], 1 or more fetuses) as this code does not include fetal measurements. However, 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) would require all of those items to be performed as defined in CPT®.

This is challenging as your physician may have not performed all of the requirements for 76805, but may have performed something more than 76815. Check with your physician if you have met the criteria for 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) even though this was later than 14 weeks.