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Ob-Gyn Coding Alert

2 New Fetal Doppler Codes Ease US Coding

Published on Sat Jan 01, 2005

Check out nonobstetric and all US procedure guidelines

Beginning Jan. 1, if your ob-gyn evaluates fetal anemia using Doppler imaging, you'll be able to report 76820 - one of two new codes CPT added for fetal ultrasounds.
 
CPT 2005 also delivers specific ultrasound coding instructions in its new guidelines, such as how to choose between "complete" and "limited" codes and what exam elements CPT considers included in 76856.

1. How to Pick 'Complete' or 'Limited'
 
When coding for all ultrasound procedures, you must adhere to CPT 2005's guidelines. Check out these new features:

 

  • All diagnostic ultrasound examinations require permanently recorded images with measurements, when such measurements are clinically indicated

     
  • A final, written report should be issued for inclusion in the patient's medical record. 

     
  • For those anatomic regions that have "complete" and  "limited" ultrasound codes, note the elements that comprise a "complete" exam. The report should contain a description of these elements or the reason that an element could not be visualized (such as, obscured by bowel gas, surgically absent, etc.).

     
  • If the ob-gyn reports less than the required elements for a "complete" exam (that is, limited number of organs or limited portion of region evaluated), you should use the "limited" code for that anatomic region once per patient exam session.

     
  • You should not report a "limited" exam of an anatomic region for the same exam session as a "complete" exam of that same region.

     
  • You can separately report Doppler evaluation of vascular structures (other than color flow used only for anatomic structure identification). 

     
  • Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process. The images and documented descriptions can exist either separately or together within the report of the guidance procedure.

     
  • You should not separately report the use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report.

    2. Learn the 76856-76857, 51798 Guidelines

    Don't be tempted to report 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) in addition to 76857 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles]). You'll find that CPT includes 51798 in 76857, as specified in the guidelines for nonobstetrical procedures.
     
    Learn what else may affect your ob-gyn practice:

    Code 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) includes the ob-gyn's complete evaluation of the female pelvic anatomy. Elements of this examination include description and measurements of:

  •  uterus and adnexal structures
  •  measurement of the endometrium
  •  measurement of the bladder (when applicable)
  •  description of any pelvic pathology (such as, ovarian cysts, uterine leiomyomata, free pelvic fluid).
     
     
  • Code 76857 represents:
     
  • focused examination limited to the assessment of one or more elements listed in code 76856 and/or
     
  •  re-evaluation of one or more pelvic abnormalities previously demonstrated on ultrasound.
  • Report 76857 for urinary bladder alone (such as, not including kidneys)
     
  • Report 51798 if the ob-gyn obtains bladder volume or post-void residual measurement without imaging the bladder.

    3. Add 76820-76821 as Obstetric US Codes

    What may thrill you the most about CPT 2005 are two new codes for fetal Doppler of the umbilical and middle cerebral arteries: 76820 (Doppler velocimetry, fetal; umbilical artery) and 76821 (... middle cerebral artery).
     
    "We will use these new codes frequently in our office, because we have four maternal fetal medicine (MFM) practitioners," says Peggy Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa.
     
    You should use 76820 to check the resistance of the placenta. Usually, the ob-gyn performs this for intrauterine growth restriction (IUGR) (small-for-dates), which can be a sign of a maternal or placental complication, Stilley says.
     
    Ob-gyns perform 76821 to evaluate fetal anemia, Stilley adds. "The physician checks for fetuses affected by isoimmunizations, Kell antibody, RH sensitization, and so on."
     
    Note: You still will not find a code for Doppler of the uterine artery. If your ob-gyn performs this service, the American College of Obstetrics and Gynecology (ACOG) recommends that you use 76827 (Doppler echocardiography ... complete) or 76828 (... follow-up or repeat study). But you may find a closer match with 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study).
     
    CPT deleted the descriptor term "cardiovascular system" from 76827 (deleted copy in bold) (Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or continuous wave with spectral display; complete).

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