CPT's 76801, 76805, 76811, 76815, 76817

OBSTETRICAL ULTRASOUND CPT CODES

    CPT 76801 – 76828 codes are ultrasound pelvis examination services only for pregnant peoples. For non-pregnant females and also for male pelvis ultrasound examination services have a different set of codes those are listed in the CPT manual under the topic Non-Obstetrical (CPT codes range from 76830 - 76857)

    1. Trans-abdominal study - Complete
    2. Trans-abdominal study - Limited
    3. Transvaginal study
    4. Follow up / Re-evaluation study
    5. Biophysical study

Trans-abdominal Ultrasound Examination:

The complete Trans-abdominal Ultrasound CPT Codes are based on the following scenarios,  

       1.   Fetal and maternal evaluation (76801 - 76810)

       2.   Fetal and maternal evaluation plus detailed fetal anatomical examination (76811-76812)

       3.   Fetal nuchal translucency measurement (76813-76814)

Limited Trans-abdominal Ultrasound: If all the required elements to code the complete US codes are not documented in the medical record or only limited study is performed then the only choice of code is CPT 76815 (Limited trans-abdominal study)

Fetal and maternal evaluation (76801 - 76810)

Elements required for a complete study, less than 14 weeks pregnant female

       -      Determination of the number of gestations sacs and fetus

       -      Fetal measurements appropriate for gestation

       -      Survey of visible fetal, placental anatomy

       -      Qualitative assessment of amniotic fluid volume / Gestational sac shape

       -      Examination of maternal uterus and adnexa.

CPT 76801 – Ultrasound, pregnant uterus, Fetal and maternal evaluation, First trimester, Trans-abdominal approach, Single / First gestation.

+ CPT 76802 – Each additional gestation

Elements required for a complete study, greater than 14 weeks pregnant female

       -      Determination of the number of fetus and Amniotic/Chorionic sacs

       -      Fetal measurements appropriate for gestation

       -      Survey of intracranial/spinal/ abdominal anatomy, 4 chamber heart, umbilical cord, placenta location

       -      Assessment of amniotic fluid volume

       -      Examination of maternal uterus and adnexa

CPT 76805 - Ultrasound, pregnant uterus, Fetal and maternal evaluation, First trimester, Trans-abdominal approach, Single / First gestation.

+ CPT 76810 - Each additional gestation

Fetal and maternal evaluation plus detailed fetal anatomical examination (76811-76812)

Elements required for complete study

       -      Apart from all elements that are listed above for CPT 76805 plus

       -      Detailed anatomic evaluation of the fetal brain/ventricles, face, heart /outflow tracts and chest anatomy, abdominal organ-specific anatomy, number/length/architecture of limbs.  

       -      Detailed evaluation of the umbilical cord and placenta and other fetal anatomy as per clinical indication.

CPT 76811 - Ultrasound, pregnant uterus, Fetal and maternal evaluation plus detailed fetal anatomical examination, Trans-abdominal approach, Single / First gestation.

+ CPT 76812 - Each additional gestation 

Fetal nuchal translucency measurement (76813-76814)

       -      This is mainly to detect any abnormalities in the cardiovascular system of a fetus.

       -      This study can be performed either by trans-abdominal or Transvaginal approach.

CPT 76813 - Ultrasound, pregnant uterus, Fetal nuchal translucency measurement, Trans-abdominal / Transvaginal approach, Single / First gestation.

+ CPT 76814 - Each additional gestation

Limited Trans-abdominal Ultrasound Study:

      -      If all the required elements to code complete Ultrasound are not documented in the medical record or only limited study is performed then the only choice of code is CPT 76815.

     

 -      CPT description stating that it’s one or more fetus, hence for any number of gestations, one unit of CPT 76815 is enough.

CPT 76815 - Ultrasound, pregnant uterus, Limited, one or more fetuses.

Follow Up (Re-evaluation) Trans-abdominal Ultrasound Study

      -      When there is need of re-evaluation of fetal size, (or)

      -      Re-evaluation of organ system with suspected abnormality (or)

      -      To confirm any abnormal findings on a previous scan report CPT 76816.

CPT 76816 – Ultrasound, pregnant uterus, Follow-up (Re-evaluation) per fetus, Trans-abdominal approach.

Note: For each additional fetus during multiple gestation examination – Append modifier 59

Eg: Twin pregnancy; follow up Trans-abdominal ultrasound exam on 10/02/2018

      76816, 76816 - 59

Transvaginal Ultrasound Study:

Transvaginal / endovaginal ultrasound is a type of pelvis ultrasound to examine the female pelvis (Uterus, fallopian tubes, ovaries, cervix and vagina). The ultrasound probe will be placed in the vagina that emits sound waves to obtain images.

CPT 76817 - Ultrasound, pregnant uterus, Transvaginal study

Fetal Biophysical profile:

       -      Is for fetal heart rate monitoring and fetal ultrasound

       -      Evaluation of breathing, movement, muscle tone, amniotic fluid level.

       -      Non-stress testing – To assess fetus heart rate changes while moving inside.

       -      Scoring is based on each of the five components (Breathing, muscle tone, movements, amniotic fluid and heartbeat) 0- abnormal and 2- normal

       -      Total score 8/10 is considered normal, below 6/10 is worrisome.

CPT 76818 – With Non-stress testing

CPT 76819 – Without non-stress testing

Note: Assessments of each additional fetus should be reported used modifier 59

Eg: Twin pregnancy; fetal biophysical profile on 10/12/2017

      76819, 76819 - 59

Ref: CPT Book AMA