Just performed a limited obstetric ultrasound? Instead of billing it with a full scan code, use CPT code 76815. Ultrasound scans are effective for monitoring pregnancies. The World Health Organization (WHO), in fact, recommends these tests to all pregnant women before 24 weeks of gestation as a precautionary step.
Therefore, sonography is a fundamental part of obstetric and gynecologic care. But are you familiar with its different codes? We are here to educate you about their differences. Let’s start with 76815.
CPT Code 76815 Description
CPT code 76815 describes one of the diagnostic ultrasound procedures. It specifically refers to a limited obstetric sonography. During the test, a healthcare provider (an obstetrician or ultrasound technician) uses sound waves to evaluate a specific aspect of a pregnancy, such as:
- The fetus’s location
- Cardiac activity
- Gestational age
- Viability of the pregnancy
In short, this ultrasound answers the most basic questions. It is not suitable for evaluating the well-being or gender of a fetus. Healthcare providers also perform a limited ultrasound to diagnose an ectopic pregnancy or to determine the management of vaginal bleeding. In simple terms, you can use the 76816 CPT code for a targeted examination of one or more fetuses.
Scenarios Where CPT Code 76815 is Applicable
The following scenarios for CPT code 76815 will further help you differentiate it from other similar options.
Scheduled Limited Obstetric Ultrasound during First Trimester
Did you know that more than 80% of maternal deaths are preventable? Ultrasound is one of the most important tests for determining whether a pregnancy is safe or not. So, for our first scenario, suppose a 24-year-old pregnant woman arrives at an OBGYN clinic during the first trimester.
The main reason? To obtain vital information about her pregnancy. The OBGYN evaluates her condition and performs a targeted ultrasound to monitor the cardiac activity of the fetus. She then uses CPT code 76815 to bill for this test.
Limited Sonography to Rule Out Placenta Previa
Placenta previa, occurring in only 1 out of 200 U.S. women, can cause severe vaginal bleeding during or after delivery. Healthcare providers usually identify this condition at the 20th week of gestation. However, they can only confirm it at the 32nd week.
So, for this example, consider a 29-year-old pregnant woman who arrives at a hospital after noticing light spotting. The healthcare provider examines her condition and learns that she is 20 weeks pregnant. Suspecting placenta previa, he calls for the technician to perform a focused obstetrical scan.
After determining the location of the placenta and its proximity to the cervix, the technician uses CPT code 76815 to bill for his role.
Determining Fetal Viability with a Limited Ultrasound
As we mentioned in the first scenario, a limited ultrasound is the only way to confirm the viability of a pregnancy. Since 6 to 8% of women in the U.S. have high-risk pregnancies each year, let’s envision a similar scenario.
Suppose a 10-week pregnant 32-year-old woman arrives at an emergency after experiencing mild cramping. The healthcare provider performs a targeted scan to monitor the fetal heartbeat. He then bills for this scan by using CPT code 76815.
Applicable Modifiers for CPT Code 76815
You can use the following modifiers with this particular code:
Modifier TC
If you only want to bill for the technical component of a limited obstetric ultrasound, append modifier TC to CPT code 76815.
Modifier 26
But if you only interpreted the sonography scan and reported it, use modifier 26 with this code. This modifier is useful for reporting the physician’s role and time spent on an ultrasound.
Modifier 59
Did you perform this limited ultrasound with another service? If the test is distinct from that service, apply modifier 59 to CPT code 76816 to request separate payments.
CPT Code 76815 Billing & Reimbursement Guidelines
Bill for the right obstetric ultrasound to avoid outright denials. For timely payments, simply follow our highlighted billing and reimbursement guidelines for CPT code 76815.
Use CPT Code 76815 for Reporting a Limited Ultrasound
We have mentioned this countless times in the blog that this code is only for a focused obstetric assessment. This includes evaluating a pregnant woman for specific problems, such as fetal heartbeat and location. Hence, avoid using it to bill for a comprehensive ultrasound.
Keep one more thing in mind! Report only one 76815 code per study, even if you have evaluated more than one fetus.
Maintain Complete Documentation
To support your claim, you must document the clinical reason for performing a focused obstetrical ultrasound. This involves a complete report with the following details:
- Date and time of the scan
- Clinical reasoning (specific information about the pregnancy)
- Factors assessed (fetal heartbeat, placental location, vaginal bleeding, or any other)
- Interpretation and findings
Specify Your Role with Appropriate Modifiers
If you have performed a specific component of this targeted scan, for example, interpretation, you must highlight it with a correct modifier. You can use modifiers TC or 26 for that.
Follow Payer-Specific Billing Rules
Insurance companies may have additional requirements for CPT code 76815. Therefore, the best way to improve your claim submission accuracy is to verify and follow payer-specific rules.
Summary
Can you now differentiate CPT code 76815 from other obstetrical scans? This should be clear by now that this code describes a limited OB ultrasound. Hence, avoid using it for a comprehensive evaluation like other OBGYN coders.
To summarize, you can follow this comprehensive guide to receive timely payments for this assessment. But if coding accuracy remains a huge problem at your practice, refer to our OBGYN billing services. We can help you file accurate claims for all types of obstetrical sonographies.
