Wiki OB coders..Please help!

[mhissy18]

Hello! I am a new OB coder and work in a private facility. I am having doubts as to how CPT code 76805, 76816, and 76811 are used. I understand that 76811 is mostly done for high-risk patients unlike 76805. Now, my concern is, I was told that a follow-up visit from 76811 is 76805. Then, 76816 is billed if the patient comes back for another follow-up. Is this correct?

Thank you,
Grace K, CPC

 

[david.wagner]

You got a good idea of the codes. 76805 is a basic anatomic scan, done AT or AFTER 14 weeks. If its before 14 week, than its a 76801. 76811 on the other hand is a detailed exam of maternal and fetal evaluation. With 76811, there are a bunch of areas that have to be checked, including, Abdominal organ specific anatomy, amniotic fluid, chest anatomy, face, fetal brain, heart anatomy, intracranial & spinal anatomy, limbs, other fetal anatomy, placental location, umbilical site insertion site, exam of maternal adnexa and Gestational sac/fetal measurements appropriate for gestational age. Each area has to be documented as well, they can't just document what was abnormal, but also list what was normal or negative. 76816 is a follow-scan, usually done to re-evaluate fetal size or because a previous abnormality seen on other scan. The physician should document that it is a follow-up scan.