Wiki help with US codes

[alisan]

I am new to OBGYN billing and need some help with US codes. A patient came in newly pregnant and had procedure code 76801 and was paid by BCN. She came in two weeks later with some bleeding and cramping so doctor is billing another 76801 and it didn't get paid. Was this the correct procedure code or should she be doing 76815? In other words is procedure 76801 only payable once during pregnancy???

 

[mcdiac]

76801 is usually the first u/s done to establish a viable pregnancy. It sounds like 76815 (quick look u/s) would be appropriate for the 2nd u/s.

76801 is usually only reimbursed once per pregnancy.

Also, depending on the insurance company, you will have to determine how many ultrasounds are allowed per pregnancy or per global package.

 

[Emmy1260]

Depends on documentation, but 76815 is the more likely choice for this type of US. Routine US may be limited by the payer. When there are complications, ie threated abortion, additional US maybe paid. Again, documentation is key to reimbursement.