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fetal gestation restriction

Tina Posted Wed 25th of March, 2015 12:26:30 PM

I have seen in several articles from supercoder that it is ok to use fetal ultrasound code 76801 for scans done on fetus that is over 14wks. I thought any code for age/gestation restrictions could not be ignored. I just read this again on your most recent radiology coding alert. Per cpt coding rules if all the elements of a ultrasound study are not performed you are to use cpt 76815. So why in the article are you all recommendting that a scan that does not supports all components of 76805 should not be coded as 76815 but should look to 76801??

Tina Posted Wed 25th of March, 2015 12:29:44 PM

when the fetus is over 16 wks (in your example)

SuperCoder Answered Thu 26th of March, 2015 05:48:01 AM

Thank you for the feedback.
Will surely get back to you with valid explanation post review and research on the pub. Thanks!

SuperCoder Answered Thu 26th of March, 2015 05:48:01 AM
Thank you for the feedback. Will surely get back to you with valid explanation post review and research on the pub. Thanks!
SuperCoder Answered Mon 30th of March, 2015 06:14:53 AM

We thank you for your patience. Our expert consultant is working on this and would reply shortly.

SuperCoder Answered Mon 30th of March, 2015 06:14:53 AM
Thank you for the feedback. Will surely get back to you with valid explanation post review and research on the pub. Thanks!
SuperCoder Answered Thu 02nd of April, 2015 06:36:02 AM

We thank you for your patience in this matter.
Please find below the response of the query.

The instruction in CPT is to code down to a limited study when the required elements of a complete ultrasound are not met. The definitions for OB ultrasounds do in fact stipulate the age of the fetus in the code descriptor, but this is to indicate that the expected work could not be accomplished if the fetus was not at least that certain age. It is not intended to convey a "complete" ultrasound for which there is a "limited" version of the same structures. If a fetus was 16 weeks gestation (by ultrasound determination, not LMP) and the physician could not visualize all of the areas denoted for code 76805, the next applicable code would in fact be 76801 if all of the elements of that exam had been documented. If less than the elements required for 76801 were documented, you would then code 76815 which is a quickie ultrasound to determine an immediate reading for the fetus, but only for the elements listed in the code descriptor.

Information has been provided to us by our consulting Expert
Melanie Witt, RN, CPC, COBGC, MA.

Tina Posted Thu 02nd of April, 2015 14:18:48 PM

Thank you for your reply, can you share the source where you all are getting this information? I might be interpreting this incorrectly but per the AMA Radiology Coding Stategies book it says "The OB ultrasound codes are classified according to: the length of gestation. Codes 76801 and 76802 are used for complete exams performed during the first trimester, while 76805 and 76810 are used for complete exams performed during the second and third trimester." 16wk gestation would be in the second trimester so I still don't understand how we can use 76801. Also the American College of Radiology states "When the pregnancy is in the first trimester (less than 14 weeks), the coder should remember that the required elements for CPT® code 76801 will be those that are "appropriate for gestation" and "visible." If any of the elements listed in the CPT code book are not able to be measured or are not visible, then the report should document that information in order to assign 76801. If any of the elements are not documented, the limited OB ultrasound study should be assigned (76815)." Sorry this is just the first time I am hearing that if all elements for the 76805 were not documented that we would use 76801 when gestation age is greater than 14 wks as the code states.

SuperCoder Answered Fri 03rd of April, 2015 05:07:53 AM

The information has been provided to you by our consulting Obstretics and Gynae expert
Melanie Witt, RN, CPC, COBGC, MA.

The instruction in CPT is to code down to a limited study when the required elements of a complete ultrasound are not met. The definitions for OB ultrasounds do in fact stipulate the age of the fetus in the code descriptor, but this is to indicate that the expected work could not be accomplished if the fetus was not at least that certain age. It is not intended to convey a "complete" ultrasound for which there is a "limited" version of the same structures. If a fetus was 16 weeks gestation (by ultrasound determination, not LMP) and the physician could not visualize all of the areas denoted for code 76805, the next applicable code would in fact be 76801 if all of the elements of that exam had been documented. If less than the elements required for 76801 were documented, you would then code 76815 which is a quickie ultrasound to determine an immediate reading for the fetus, but only for the elements listed in the code descriptor.

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