Wiki Coding for Nuchal Translucency ultrasound in first trimester

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anuja.devasthali

anuja.devasthali

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:)Hello friends,

Please help me with this !

Our OB-GYN provider schedules a patient for nuchal translucency ultrasound in first trimester ( around 10-14 weeks ). Normally she does it with transabdominal approach. In case of one patient she tried to do nuchal translucency ultrasound with transabdominal approach but due to maternal body habitus and fetal position she also used transvaginal approach to evaluate nuchal translucency.

CPT 76813 describes " Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation "

In this case should we report CPT 76817 separately with CPT 76813 since the CPT description is for either of approaches & not for both the approaches ?
If yes, is there any modifier required for CPT 76817 or 76813.
Also please provide referrence document if you have any.
 
I would opt to report 76813 and76817( For Primi and or singleton). No modifier( any way the payer may reduce for multiple procedures Mod- 51)
why 76817 in additon to to 76813 is because there is parenthetical note down the code 76817 saying"If transvaginalexaminationis done in addition to trasnsabdominal OB US exam, use 76817 in addition to appropriate transabdominal exam code.
But you did not denote whether it was first gestation (Primi) / multi or singleton or multiple gestation because the code determines on those factors.
Thank you.
 
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I would only bill the 76813 since the discription states transabdominal OR transvaginal approach.
 
But the doctor did both, may be for a better view or result whatever. Did and documented. But what about the parenthetical notes Would you not take it. You cannot bundle them both either.
Each different route and differs in technique too.

I strongly believe in reporting both, without bundling them.

May I have a valid explanation for your reporting please?

Thank you
 
76813 & 76817

I agree with Preserene to code for both. I also believe the payor will reduce the reimbursement because both procedures were done for the same reason. I would send in documentation for a denied claim. The provider did it for a reason and should document why he had to do it both routes and it would give the payor a reasonable explanation.
You should let us know the outcome : )

Barbara
 
Thank you Barbara and Dondon I appreciate your expert view. It gives me strength to move forward.
 
76813 76817

Per SMFM coding comittee: "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.”
 
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