Overcome Confusion When Reporting Ob Ultrasounds
Published on Sat Sep 01, 2001
Reporting obstetrical (ob) ultrasounds has long been plagued with problems. Definitions of the relevant codes are unclear or confusing, and some code combinations are routinely denied even though Medicare national policy indicates the services may be reported together.
These problems have been exacerbated in recent years because ultrasounds (U/S) are being ordered more frequently than ever. Fifteen or 20 years ago it was routine for a primary care physician or obstetrician to order a single ultrasound during pregnancy (V22.2, normal pregnancy; pregnant state, incidental). More recently, two are often performed -- one in the first trimester, and a second later in the pregnancy. This trend has opened the door to even greater confusion -- and even greater chances for denial and lost revenue.
"Ultrasound is often done at eight or 10 weeks to get an overall picture of the pregnancy," explains Pat Kirkham, RDMS, sonographer with Randallwood Radiology, a private practice of three radiologists in St. Charles, Ill. "This study is something of a screening and helps rule out some of the common prenatal defects. This stage of development is also the time when we can most accurately measure the fetus to determine the date of gestation." The second U/S, frequently performed at 18-22 weeks, provides greater detail about the condition of the fetus (e.g., whether organs are developing along a normal timeline).
Ob ultrasounds may be conducted in one of two ways. The more traditional approach is transabdominally, where the patient is asked to fill her bladder, and a transducer is moved across her lubricated abdomen. Ultrasonic waves bounce off the bladder to create images of the uterus, its contents and surrounding organs. As an alternative, U/S may be conducted transvaginally, where the probe is inserted into the vagina. "The transvaginal approach provides the sonographer with a different perspective of the organs being studied," explains Jacqui Szymanski, RT (R), M, practice administrator for Associated Imaging Specialists in Elgin, Ill. "The different vantage point means that the images produced are much more detailed."
Match Transabdominal Code With Study
Four transabdominal codes are available:
CPT 76805 -- echography, pregnant uterus, B-scan and/or real time with image documentation; complete (complete fetal and maternal evaluation)
CPT 76810 --... complete (complete fetal and maternal evaluation), multiple gestation, after first trimester
CPT 76815 -- ... limited (fetal size, heart beat, placental location, fetal position, or emergency in the delivery room)
CPT 76816 -- ... follow-up or repeat.
The American College of Obstetricians and Gynecologists (ACOG) defines the complete study as primarily an anatomical evaluation. The fetal component includes head measurements and an examination of the neck, abdomen, chest, limbs and internal organs. Fetal life signs -- heart rate, breathing and movement -- are also noted. However, because the fetus is not developed sufficiently during the first trimester [...]
