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Reimbursement Advisor


Third-trimester ultrasound scans

October 2003 · Vol. 15, No. 10

<huc>Q</huc> When a patient is scanned during the third trimester for indications such as advanced maternal age, pregnancy-induced hypertension, a large-for-gestational-age fetus, oligohydramnios, or shortened cervix, which code should I use: 76811, 76815, or 76816?

<huc>A</huc> Your choice of code will depend on what was documented previously and which elements of the scan are being documented at the present time. (I am assuming there was an initial scan, usually reported using codes 76801-76810)

Use code 76811 (ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation) only when all of its elements are performed. If you are scanning for 1 or more of the conditions you have listed but not performing all the elements included in 76811, your coding choice is either 76815 (ultrasound, pregnant uterus, real time with image documentation, limited) or 76816 (ultrasound, pregnant uterus, real time with image documentation, follow-up…, transabdominal approach, per fetus).

It all boils down to what was known before this scan was ordered. If 1 or more of the conditions you listed were discovered at the time of a previous scan and now require ongoing monitoring, use code 76816. If 1 or more of the conditions mentioned are only now in evidence, use code 76815.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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