ACOG FAQ from 2012-
Q: Is code 76813 bundled into 76801?
A: No. These codes represent unique services. According to the ACOG OBGYN Coding Manual: Components of Correct Procedural Coding, if both codes are performed, report them separately (eg, 76801, 786813). When reporting multiple radiology services, most payers do not require a modifier 51. Instead, both services will be reimbursed at their full allowable amount. Although not required, it is best to have two distinct diagnosis codes to reflect the medical necessity of performing both.
The ACOG OBGYN Coding Manual lists the components of 76813 as including the following:
1. orientation of transducer to mid-sagittal view of the embryo
2. crown-rump measurement
3. observation of embryo at high magnification until the embryonic neck is in a neutral position and spontaneous embryonic movement allows for differentitation between the outer edge of nuchal skina nd the amnion
4. at least 3 separate measurements for the shortest distance between the inner edges ofnuchal translucency
5. comparison of the alrgest measurement from an acceptable image to crown-rump length and gestational age specific medians
Code 76817: This may include evaluation of the fetus and placenta and evaluation of the maternal uterus and adnexae.
Per SMFM: "76817 should not be billed if vaginal scanning is done solely to obtain the nuchal translucency measurements (CPT 76813) of first trimester genetic screening, because 76813 can be with either transabdominal or vaginal approach, or both. Both CPT 76817 and 76813 may be billed together, if the transvaginal scan is done for a clinically appropriate reason, other than NT measurement.”