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The use of cpt 76811- need help

  1. Question The use of cpt 76811- need help
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    Hello fellow Coders,

    I need clarification on what you and your practice would do in the current situation we have right now in our OB/GYN practice.

    Is it correct coding use of 76811 for ALL screening 18-20 week gestation ultrasounds done, if the sonographer is qualified and we have the proper equipment and a complete ultrasound is done? Or is it proper to be using the 76805 for these screening 18-20 wk gest ultrasounds?


    I have done research through ACOG and their stand on this is that the 76811 should NOT be used to report a routine screening ultrasound.

    I need feedback as to what my fellow Coders would do?

    Thank you, and I appreciate any feedback I receive.
    Last edited by cfuentes; 06-21-2011 at 02:06 PM.

  2. #2
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    I understand that 76811 & 76812 describe an extensive fetal ultrasound evaluation and detailed anatomic survery required for pregnancies at elevated risk of congenital abnormalities of fetal development (birth defects). The documentation entails much more than the 76805 and 76810. We always use the 76805 and 76801 at all our centers depending upon the age of the fetus. Hope this helps.

  3. Default
    Thanks for your reply Jackie,

    I appreciate your in put, which strongly supports my thought on using the 76805 vs the more detailed 76811 for the screening ob ultrasound.

  4. Default 76811
    Why does some carriers deny this CPT iwth Dx V28.3 as non covered with DX?

  5. #5
    Default
    Quote Originally Posted by cfuentes View Post
    Hello fellow Coders,

    I need clarification on what you and your practice would do in the current situation we have right now in our OB/GYN practice.

    Is it correct coding use of 76811 for ALL screening 18-20 week gestation ultrasounds done, if the sonographer is qualified and we have the proper equipment and a complete ultrasound is done? Or is it proper to be using the 76805 for these screening 18-20 wk gest ultrasounds?


    I have done research through ACOG and their stand on this is that the 76811 should NOT be used to report a routine screening ultrasound.

    I need feedback as to what my fellow Coders would do?

    Thank you, and I appreciate any feedback I receive.

    It depends on what was ordered, documented and the reason for doing the exam. If it is a twin pregnancy, the mother is obese, has diabetes, or something like that and the documentation supports 76811 then I would bill that.

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