![]() Assessment for findings that may increase the risk of aneuploidyħ6811 CPT Code Description: One detailed anatomic ultrasound (CPT 76811) is allowed per pregnancy when performed to evaluate for suspected anomaly based on history, laboratory abnormalities, or clinical evaluation or when there are suspicious results from a limited or standard ultrasound.Evaluation of fetal condition in late registrants for prenatal care A duplex ultrasound is a procedure used to visualize the pattern and direction of blood flow in arteries and veins via real-time images.Evaluation with a history of previous congenital anomaly.Follow-up evaluation of placental location for suspected placenta previa.Follow-up evaluation of a fetal anomaly.Maternal Category O35 is used to designate maternal care for known or suspected fetal abnormality and damage. All of the leading codes begin with the letter O and not the number zero. Evaluation for abnormal biochemical markers The CPT Code book has separate codes for reporting Obstetrical Ultrasound verses Gynecologic/Non-. ICD-10-CM Coding Rules All fetal anomaly codes begin with a maternal code followed by a fetal code.Evaluation of prelabor rupture of membranes or premature labor.Evaluation of suspected placental abruption.Evaluation of suspected amniotic fluid abnormalities.Evaluation of suspected uterine abnormality.Evaluation of suspected ectopic pregnancy. ![]() Examination of suspected hydatidiform mole. ![]() Evaluation of discrepancy between uterine size and clinical dates.Adjunct to amniocentesis or other procedure.Evaluation of suspected multiple gestation.Similarly, report 76817 only once for transvaginal ultrasound, even when there is more than one gestation. Evaluation of abdominal and pelvic pain For limited ultrasounds, CPT says to report 76815 once, regardless of the number of fetuses.In my practice the question has been raised about billing a bpp and a limited with IUGR patients. Modifier 59 would be necessary on 76815 if billing in these situations, and you would need to ensure that the appropriate ICD-10 code supporting each service is properly linked to the CPT code. In some limited circumstances, they may be billed together, if the indications exist for doing both, and the 76815 is being done to evaluate something that is not included in the BPP (fetal position, placental location). Jones is correct that BPP (76818, 76819) and limited (76815) generally cannot be billed together. This would be unique to that payer and should not be generalized to all situations.ĭr. ![]() Some payers may restrict you from billing 76815 or 76816 along with a BPP. On the other hand, billing for 76816 + 76815 would never be appropriate because all the elements of a limited study would be included in a follow-up study. Similarly, a follow-up study 76816 can also be billed with a BPP if there is a distinct indication for each. If you have an indication to do a BPP and a distinct indication to do a limited study (placenta or presentation), billing a BPP and a limited study would be appropriate in those situations. If there is no pregnancy then the ultrasound is considered nonobstetrical and code 76830 should be used. Evaluation of the placenta or presentation are not included in a BPP evaluation. The CPT Codes for obstetrical transvaginal ultrasounds are: 76813, 7687. A limited ultrasound study is usually done for fluid check, viability, placenta evaluation, and/or presentation. BPP is a test of fetal well-being, with specific elements included in its description. The CPT descriptions and the respective elements of any study should be carefully considered in answering this question. While billing for a BPP + limited study may not be common, there are clinical situations where billing both is certainly appropriate. ![]()
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