| September 2003 · Vol. 15, No. 9 REIMBURSEMENT ADVISER
Focus on Obstetric UltrasoundMELANIE
WITT,
RN, CPC, MAMs. Witt, former program manager, Department of Coding and Nomenclature, American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt, check with your individual payer.
Q Are CPT 76805 and 76811 different? Both are for fetal and maternal ultrasound evaluation, yet 76811 includes a detailed fetal anatomic exam. Our ultrasonographer says she always does a detailed fetal exam.
A Code 76811 (ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus a detailed fetal anatomic examination, transabdominal approach; single or first gestation) requires both basic examination of fetal and maternal structures included with code 76805 (determination of number of fetuses and amniotic/chorionic sacs; measurements appropriate for gestational age; survey of intracranial, spinal, and abdominal anatomy; 4-chambered heart; umbilical cord insertion site; placenta location; amniotic fluid assessment; and maternal adnexa), and a detailed examination of fetal anatomy. This includes evaluation of fetal brain and ventricles; face; heart and outflow tracts and chest anatomy; abdominal organ-specific anatomy; number, length, and architecture of limbs; and detailed evaluation of the umbilical cord, placenta, and other fetal anatomy that may be clinically indicated.
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