MFMcoder
Networker
Hello - I am needing help with an audit that says I should bill a 76815 instead of a 76801 with a 76813 for an NT study. Is there any resources out there that can help me?
Do you mean NST? If so it would be 59025. I work in the OB triage and following listed are the most CPT codes we use for US.Hello - I am needing help with an audit that says I should bill a 76815 instead of a 76801 with a 76813 for an NT study. Is there any resources out there that can help me?
In order to bill both 76801 and 76813 you need to have both separately documented. If the only purpose of the exam was for the nuchal translucency then you only bill 76813 and this code is used whether the ultrasound is done vaginally or abdominally. 76815 is for a single quick measurement and would not be appropriate for a complete abdominal ultrasound (and documented as such) with NT study. You need to look at the documentation and then appeal the finding if you have met the requirements for both codes.Hello - I am needing help with an audit that says I should bill a 76815 instead of a 76801 with a 76813 for an NT study. Is there any resources out there that can help me?
So a nuchal scan, as represented by CPT code 76813, includes only the measurement of the nuchal fold. That is, your documentation should show that the transducer was oriented on the neck area of the fetus and that 3 measurements were taken of the amount of fluid present (they use the largest measurement) but then must compare that to crown-rump length and gestational age. This diagnostic screening test is done to detect possible chromosomal abnormalities such as Down’s Syndrome and is only a meaningful measurement if performed prior to 14 weeks gestation because the fluid is absorbed as the fetus grows. The crown-rump length is not measured as an integral part of the NT work for which the code was valued under the relative value system and in fact a previous ultrasound result (for instance is they did first trimester screening a few days before) can be used.We also are looking for some help with billing 76815 with 76813. Report shows transabdominal ultrasound with measurements for CRL, Cervix Length, FHR, and NT. I am trying to find documentation what is needed for the NT study and since the FHR and Cervix Length were also done would this support the 76815 to be billed with the 76813? Also, would we need a 59 modifier on the 76815 if able to bill them both