Quite right Tracy. In fact, the AMA CPT Assistant had an article a few years back (about an ultrasound performed in the ER) that supports this. You code the ultrasound type based on what the provider is looking for. If he/she is suspecting pregnancy, then an ob ultrasound would be coded, even if the result was no pregnancy. Likewise, if he/she suspected an ovarian cyst and a pregnancy was found, a gyn ultrasound is coded instead.
Thank you, Nielynco - I had actually been researching and putting together some information I located for our coding team, regarding OB Diagnostic Ultrasounds - and I totally misunderstood my initial reference I posted just a few days ago - meaning that if the ectopic pregnancy is 'discovered' during the transvaginal and no follow-up is ordered, than a Non-OB would be reported.
Nielynco - what is a fetus is not identified (as in an ectopic pregnancy) and the facility reports a Non-OB transvaginal, followed by OB transvaginal, following HCG positive (tub ligation)? I know that CCI edit prevents Non-OB with OB, even with a modifier. So, obviously with the initial transvaginal, there is not a 'review/report' on the components needed for the OB transvaginal 76817. Thank you, in advance, for any assistance.
Report codes 76801 and 76802 only during the first trimester of pregnancy (less than 14weeks.)
Code 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation, survey of visible fetal and placental anatomic structure, qualitative assessment of amniotic fluid volume/gestational sac shape, and examination of the maternal uterus and adnexa.
Report code 76802 in addition to code 76801 for each additional fetus studied when there are multiple fetuses.
If a patient is clinically pregnant (positive HCG) and the gestational sac and fetus cannot be identified as long as they have been sought, code 76801 can be reported. If these elements aren’t mentioned, it is a limited study reported with code 76815.
Report code 76805 for routine OB ultrasound after the first trimester of pregnancy. Report addon code 76810 for each additional gestation.
Codes 76805 and 76810 include determination of number of fetuses and amniotic/chorionic sacs, measurements appropriate for gestational age, survey of intracranial/spinal/abdominal anatomy, four-chambered heart, umbilical cord insertion site, placenta location and amniotic fluid assessment, and (when visible) examination of maternal uterus and adnexa. The maternal adnexa must be mentioned in the report.
Report code 76810 in addition to code 76805 for each additional fetus studied when there are multiple fetuses.
If non-obstetrical ultrasound is ordered and a fetus is identified, it should be reported as a non-obstetrical study (76856 or 76857) unless a complete OB ultrasound is subsequently requested.
Report code 76811 for an extensive ultrasound exam performed for a pregnancy when there is a high risk of fetal birth defects. Report add-on code 76812 for each additional gestation.
Codes 76811 and 76812 include all elements of codes 76805 and 76810 plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs, and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated. There must be documentation of the medical necessity for performing this detailed study. There must be reason to suspect there could be a congenital anomaly.
Report code 76812 in addition to code 76811 for each additional fetus studied when there are multiple fetuses.
Do code nuchal translucency (76813) in addition to complete or limited first trimester OB ultrasound when both are performed. Report add-on code 76814 for each additional gestation. Nuchal translucency includes a detailed evaluation of the soft tissues of the posterior aspect of the fetal neck, which is not part of the OB ultrasound. This test should be performed during the 11th to 14th weeks of gestation.
Report add-on code 76814 in addition to 76813 for nuchal translucency studies performed on additional fetuses.
Codes 76813 and 76814 can be performed transabdominally or transvaginally.
Code 76815 represents a focused quick look exam limited to the assessment of one or more of the elements listed in codes 76801-76812.
Report code 76815 when all the required elements in codes 76801-76812 are not documented in the physician report.
Do not use code 76815 more than once during an encounter, as it includes imaging of multiple fetuses and multiple elements.
Report code 76816 if the ultrasound exam is a reassessment of an abnormality discovered on a previous ultrasound exam. Code 76816 is also used to report the re-evaluation of fetal anatomy not visualized well on a previous study.
Code 76816 describes an examination designed to reassess fetal size and interval growth or re-evaluate one or more anatomic abnormalities of a fetus previously demonstrated on ultrasound. It should be coded once for each fetus requiring reevaluation using a distinct procedure modifier for each additional examined fetus.
Code 76817 describes a transvaginal obstetric ultrasound performed separately or in addition to one of the transabdominal examinations described above. It should include evaluation of the uterus, endometrium, ovaries, and adnexa. When both are reported, best practice is they should be in separate reports or separate sections of a report.
Report code 76817 one time, no matter how many fetuses are involved.
Do not use code 76817 for non-obstetric transvaginal ultrasound. Report code 76830, Ultrasound, transvaginal.
Report OB ultrasound codes for any study that begins as pregnancy-related (patient has been verified as pregnant) even if the final diagnosis is non-pregnancy related.
References:
- ACR, Online Guide to Ultrasound Coding, FAQs, 2012
- ACR, Ultrasound Coding User’s Guide
- ACR Radiology Coding Source, Volume 62, Issue 7, July-August 2007
- Baby Center, Nuchal Translucency (NT) Scan, 2014
- Clinical Examples in Radiology, Winter 05:3, Winter 07:6, Summer 10:9, Summer 11:10, Summer 12:11, Winter 15:8-9, Winter 16:13, Spring 19:9-11, Winter 20:13, Summer 20:10, Spring 20:13, Winter 20:12
- Coding Clinic for HCPCS, Third Quarter 10:7
- CPT Assistant, Dec 01:6, Mar 03:7, Nov 03:14, Nov 04:10, Nov 05:15, Dec 05:3, May 10:9, Nov 11:10, Jul 16:9
- CPT Changes: An Insider’s View 2003
