I think it depends what was coded on the initial U/S. Not being albe to visualize all the anatomy still can get you a 76811. But, it should not be coded twice in a row, just because things couldn't be visualized the first time.
I would go by the age of the fetus (< or > greater than 14 weeks), by what was documented, and check what was coded on the previous visit to avoid coding the same CPT twice.
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