Ob-Gyn Coding Alert

Reader Question:

Only Reviewed Ultrasound? Find Out If You Can Use Mod 26

Question: Patient had 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [eg, fetal heartbeat, placental location, fetal position and/or qualitative amniotic fluid volume], 1 or more fetuses) and 76819 (Fetal biophysical profile; without non-stress testing) done on 1/5/19 (with breech presentation) as well as 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) and 76700 (Ultrasound, abdominal, real time with image documentation; complete) (due to flank pain, with cephalic presentation) on 1/20/19 (both performed in the hospital). I’ve read in the archives that the doctor would need to interpret the report and write a formal report in order to bill for professional component (modifier 26). If our doctor merely reviews, then I’m assuming nothing can be billed?

Texas Subscriber

Answer: Correct. A review would constitute medical decision-making, not the professional interpretation and written report.  


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