Ultrasound Question for the Week of January 16, 2017

Question:

Question:

 I have a question regarding CPT 76805 and 76811. Currently, we are charging 76811 for our second trimester ultrasounds, but I am not sure this is correct. The American Institute of Ultrasound Medicine (AIUM) suggests a more detail exam such as tongue, palate, ear position, superior vena cava (SVC)/inferior vena cava (IVC) etc. If this is true then we probably should only be charging CPT 76805. What is your opinion?

Answer:

Answer:

Most of the time you should be assigning the following code for an obstetric (OB) ultrasound >14 weeks:

76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation

You would never assign 76811 for a routine OB ultrasound. It would be assigned only for high-risk pregnancies with known or suspected fetal anatomic or genetic abnormality (i.e., previous anomalous fetus, abnormal scan this pregnancy, etc.), or increased risk for fetal abnormality (e.g., AMA, diabetic, fetus at risk due to teratogen or genetics, abnormal prenatal screen). Some payers will only allow 76811 when performed by or ordered by a maternal-fetal specialist.

76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

More information about the above can be found in the Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination: Indications, Components, and Qualifications at http://www.jultrasoundmed.org/content/33/2/189.full.