Radiology Coding Alert

Question: Our physician performed an ultrasound in a patient with an unknown last menstrual period (LMP) who came in for confirmation of pregnancy. The gestation was confirmed to be 16/2 weeks by ultrasound. Our physician did measurements and studied the fetal heart tones (FHTs) as well as looked at the baby’s heart. Which US code would be best for this? Is it correct to report code 76815?

California Subscriber

Answer: You should not report 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. On the other hand, 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) may not seem an appropriate choice as this would require all of those items to be performed as defined in CPT®.

In other words, you may have not performed all of the requirements for 76805, but you performed something more than 76815. It is likely that you may 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.