Radiology Coding Alert

Question: An ob-gyn referred a patient pregnant in her second trimester to our radiology practice for an obstetrical ultrasound with a detailed fetal anatomic examination. The patient is pregnant with her first child.

Do I need to report 76805 and 76811?

Colorado Subscriber

Answer: For this situation, you need to report only 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation). According to the guidelines before the obstetrical pelvic ultrasound codes in the CPT^® code set, 76811 includes all the elements of 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) “plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated.”

During the procedure, the provider performs a transabdominal ultrasound study of the mother and fetus and examines the fetal anatomy. The fetal anatomy includes:

• Heart rate
• Amniotic fluid levels
• Placenta location
• Size of the ventricles

CPT^® code 76811 should be used when the provider performs a detailed exam of the fetus separate from a routine fetus and mother examination. Additionally, +76812 (… each additional gestation (List separately in addition to code for primary procedure) is an add-on code used to identify a mother with multiple gestations in a single pregnancy (for example, twins or triplets). When a mother is pregnant with more than one fetus, and the examination is performed on multiple fetuses, then you should assign +76812 for each additional fetus.