Ob-Gyn Coding Alert

Reader Questions:

You’ll Hit a Wall Trying to Bill 2 Ultrasounds

Question: Can you bill 76811 and 76815 on the same day with a modifier 59 (Distinct procedural service)? Should we consider this a bundled service and use one or the other?

California Subscriber

Answer: In general, 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses) would be inclusive of some of the things that would be viewed when the ob-gyn did 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation). In fact, this is a National Correct Coding Initiative (NCCI) bundle that does not permit the use of a modifier to bypass it. If these two occurred at two different sessions, you may have a shot but only on appeal.

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