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Radiology Coding Alert


Follow-Up U/S Warrants 76815-76816

Question: The physician ordered an obstetrical ultrasound to check placental position for a patient with previous placenta previa. The fetus gestational age was 37 weeks, and it was the patients sixth ultrasound. Should I report 76816 or 76805?

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Answer: Because this qualifies as a follow-up ultrasound, you should report either 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], one or more fetuses) or 76816 (Ultrasound, pregnant uterus, real time with image documentation, follow-up [e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan], transabdominal approach, per fetus).

If you simply checked placental location, you should report the limited-study code 76815, which is known as the quick look code.

If you performed other services, such as evaluating fetal size and confirming organ function, you should report 76816 instead.

According to the March 2003 CPT Assistant, 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) includes determination of number of fetuses and amniotic/chorionic sacs, measurements appropriate for gestational age (> or = 14 weeks 0 days), such as biparietal diameter head circumference, femur length and abdominal circumference, survey of intracranial/spinal/abdominal anatomy, four-chambered heart, umbilical cord insertion site, placenta location and amniotic fluid assessment and, when visible, examination of maternal adnexa.

This comprehensive code represents services that you most likely performed during the patients initial ultrasound, and you should not report it for the follow-up.

The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; and Gary S. Dorfman, MD, FACR, FSIR, the Society of Interventional Radiologys representative to the AMAs CPT Advisory Committee.

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