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Maternal – Fetal Medicine Billing and CPT Codes

Tremendous advances have been made in healthcare during pregnancy and child birth. From basic check-ups to advanced screenings, obstetrical procedures strive to ensure the safety and health of both the mother and the baby. Women planning to have a baby can start their medical check-ups pre conception and continue with regular check-ups right through the course of their pregnancy and after. Depending on the advice of the doctor, procedures to check on the health of the fetus may include Doppler velocimetry, ultrasound, echocardiography, Doppler umbilical scan, Doppler cerebral artery scanning etc.

While both regular pregnancy and maternal-fetal screening tests are used to check on the health of the mother and the fetus during the course of the pregnancy and post delivery, there is a significant difference between the CPT codes used for billing the procedures and services performed. Services performed from the 8th week after gestation to around one and a half months post delivery is considered as a part of maternal-fetal medicine.

An ultrasound can be recorded at any stage of the pregnancy. However, fetal ultrasound should only be performed if there is a medical indication that needs to be examined. It is inappropriate to use the screening to determine fetal sex or to just provide a picture or view the fetus.

CPT codes for Ultrasound

For medical billing purposes, ultrasound recordings are listed under the CPT codes ranging from 76801 to 76819. The code ranges are based on the following scenarios:

  • 76801 – 76810 used for billing maternal and fetal evaluation
  • 76811 – 76812 used for billing the above and detailed fetal anatomical evaluation
  • 76813 – 76814 used for billing fetal nuchal translucency measurement
  • 76815 used for billing limited trans-abdominal ultrasound study
  • 76816 used for billing follow-up trans-abdominal ultrasound study
  • 76817 used for billing trans-vaginal ultrasound study
  • 76818 – 76819 used for billing fetal biophysical profile

CPT 76801

CPT code 76801 is used for billing maternal and fetal trans-abdominal ultrasound evaluation in the first trimester of pregnancy in the single or first gestation. The screening is conducted between the eight and fourteenth week of pregnancy and should be performed if indications include any of the following:

  • Confirmation of cardiac activity
  • For facilitating safety after embryo transfer, sampling for chorionic villus, or after intra-uterine device removal.
  • Confirmation of intra-uterine pregnancy
  • Check for fetal anomalies
  • Check for and evaluate ectopic pregnancy
  • Check for uterine abnormalities or adnexal masses
  • Check for multiple gestations
  • Evaluation in case of pelvic pain
  • Evaluation in case of vaginal bleeding
  • Evaluation if hydatidiform mole suspected
  • Estimation of gestational age
  • Screening for fetal aneuploidy

In order to use CPT 76801, it is important that all the following elements required for a complete study are covered – adnexa and maternal uterus examination; assessment of shape of the gestational sac and amniotic fluid volume; determine gestation sacs and fetus numbers; measurement of fetus; and placental anatomy/visible fetal survey.

CPT 76811

In case of any suspected genetic abnormality, it may be necessary to perform an ultrasound during the second or third trimester of pregnancy. CPT code 76811 is used for billing this ultrasound screening which is used for evaluation of the fetal brain, heart, abdominal organs, face or umbilical cord. This ultrasound is performed if in addition to the indications under CPT code 76801; any of the following indications are suspected or need to be evaluated.

  • Check fetal presentation
  • Check for any abnormal biochemical markers
  • Premature rupture of membranes
  • Cervical insufficiency
  • Fetal death
  • Placental abruption
  • Uterine abnormality
  • Evaluation of any fetal anomaly

However, a detailed anatomic examination through fetal ultrasound is only required in case of a suspected or known increased risk of fetal or genetic abnormality. It is also not necessary to perform more than one detailed fetal anatomic examination through ultrasound in one pregnancy unless there are suspected problems under a new diagnosis.

CPT 76813

CPT code 76813 is used for the evaluation through measurement of fetal nuchal translucency as one of the components during screening for fetal aneuploidy. This ultrasound screening is performed between the tenth and fourteenth week of pregnancy. The screening provides an in depth examination of the fetus. In order to use CPT 76813, documentation will be required that indicate crown – rump measurement, fetal viability and nuchal thickness.

Why MedConverge

Incorrect use of codes can lead to delays and denials of your medical billing reimbursements. Our certified and experienced coders can help you with all your billing requirements and ensure that you receive complete and timely payments for your services. Contact us for your maternal-fetal medicine billing requirements.


References

  1. 76813 – CPT® Code in category: Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach. (2018). Retrieved July 10, 2018, from www.findacode.com: https://www.findacode.com/cpt/76813-cpt-code.html
  2. CPT 76801, Under Diagnostic Ultrasound Procedures of the Pelvis Obstetrical. (2018). Retrieved July 10, 2018, from www.coder.aapc.com: https://coder.aapc.com/cpt-codes/76801
  3. CPT’s 76801, 76805, 76811, 76815, 76817 . (2018, March 05). Retrieved July 10, 2018, from www.codingprime.blogspot.com: http://codingprime.blogspot.com/2018/03/how-to-code-ob-ultrasound-cpts-76801.html
  4. Dustman, R. (2015, April 01). Gather Components for OB Ultrasound Codes 76805 and 76811. Retrieved July 10, 2018, from www.aapc.com: https://www.aapc.com/blog/30124-gather-components-for-ob-ultrasound-codes-76805-and-76811/
  5. Ultrasound for Pregnancy. (2018). Retrieved July 10, 2018, from www.aetna.com: http://www.aetna.com/cpb/medical/data/100_199/0199.html

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