Elements to Get Your Ob-Gyn Ultrasounds Paid

A type of medical billing claim that prompts a lot of confusion, is the ultrasound. Nearly three-quarters of women will undergo at least one ultrasound during their pregnancies, normally between 18 to 20 weeks gestation. In fact, the American College of Obstetricians and Gynecologists (ACOG) maintains that one complete ultrasound should be included as a part of routine obstetric care.

Knowing whether to code as a routine ultrasound or detailed ultrasound – check the reasons why it was done. One confusing point is when a patient is suspected of having abnormalities of the uterus or placenta; an ultrasound can determine whether or not further medical intervention is necessary during the pregnancy.

Indications of a routine ultrasound will include observations about fetal growth, uterine size to determine if there are any date descrepancies in the pregnancy, abnormal alpha-fetoprotein, suspected abnormalities of the placenta and/or fetus, reasons for vaginal bleeding or amniotic fluid leakage. For any of these items you should look towards using code 76805 as it does not include a detailed fetal anatomic examination. If there are other elements that make up a more detailed ultrasound you will need to be sure you use 655.83 (Other known or suspected fetal abnormality, not elsewhere classified; antepartum condition or complication).

For either type, documentation is key. Whether the Ob-Gyn did a routine or detailed you need to make sure the documentation for the ultrasound tells the tale so your claim gets reimbursed.

View all Articles by: Kathryn E, CCS-P - Retired