Wiki OB Ultrasound coding

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Rgreen0118

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Patient came in as a new OB. We did an ultrasound and found out she was already 15 weeks 5 days. Too late to bill out CPT 76801, though we did the components of one. The physicians do not like to do the Fetal Anatomy scan, 76805 until they are at least 18-19 weeks. She is scheduled to come in 3 weeks for her FAS.

What code can we bill out for this days visit? Patient did not present with any problems. Can we bill out the 76801 even though we found out upon ultrasound that she is 15 weeks?

Does anyone have any documentation on ultrasound coding that they can share?

Thanks!
Rhonda
 
76805 is not only billable as a Fetal Anatomy Scan with V28.81, it can be used more than once per pregnancy with the applicable dx such as V23.7 in this case, or an indication listed in 630-679.13. If for some reason insurance denies this claim or the Anatomy Scan claim the denial should be appealed with doccumentation and paid.
 
my understanding is that there are certain requirements on the 76805, measurements, # of fetuses, survey of intracranial anatomy, spinal anatomy, to name a few. I am not sure of the necessity of using that cpt code with the V23.7 and definitely not aware that you could use 630-679 with that ultrasound code. Do you have some documentation that you could fax or email me?

Thanks!
 
Rhonda, you can also check the March 2003 CPT assistant which goes into alot of detail about the Ultrasound codes and the requirements for them.
 
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