Radiology Coding Alert

Question: We performed an obstetric ultrasound on a patient who was 17 weeks pregnant. The report noted fetal demise and that the fetus was only eight weeks in size. Should we report 76801 or 76805 for this service?

Maine Subscriber Answer: You should select the appropriate obstetric ultrasound code based on the fetus' age, not the corresponding fetus size. Although the fetus only measured the size of an eight-week-old gestation, the patient was actually 17 weeks pregnant, so you should report 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).

Code 76801 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester [< 14 weeks 0 days], transabdominal approach; single or first gestation) would only apply if the patient was less than 14 weeks pregnant. -- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; Deborah I. Churchill, president of Churchill Consulting Inc.; and Gary S. Dorfman, MD, FACR, FSIR.