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The Mysterious World of OB Ultrasound Coding

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The Mysterious World of OB Ultrasound Coding

CPT Code 76811 Ultrasound, pregna nt uterus, real time with image documentation, fetal an d maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

http://static.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/16f6616f-8c79-4d59-9b97-6d29ecbaee89/2f64d6c1-d307-46b9-b8b7-4cf75bf534e2.pdf

Date added: May 29, 2012 - Views: 67

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Coding for multiple ultrasounds - CODING AND COMPLIANCE

M ak in g sen se of th e cod es Dr. Cassio's services. Dr. Cassio reported CPT code 76805 to describe the initial screening U/S (Figure 1).

http://www.codingandcompliance.com/news/NewsArticleFiles/MultipleUltrasounds.pdf

Date added: December 20, 2011 - Views: 68

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Obstetrical Ultrasound Coding and the Radiology Report

Obstetrical Ultrasound Coding and the Radiology Report Obstetrical (OB) ultrasound studies must be well documented in order to support the CPT® code(s) chosen.

http://www.acr.org/~/media/ACR/Documents/PDF/Economics/Coding%20Source/2009%20Jul%20Aug/Obstetrical%20Ultrasound%20Coding%20and%20the%20Radiology%20Report.pdf

Date added: December 19, 2013 - Views: 2

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Ultrasound Policy Overview - MultiPlan

TXPEC-0489-12 Issued August 2012 . Ultrasound Policy Overview. What is the Amerigroup policy on prenatal ultrasounds? Members are covered for one routine prenatal ultrasound per pregnancy — CPT code 76801 or 76805.

http://www.multiplan.com/phcsmedicaid/pdf/TTC-AGP7_PU_Ultrasound.pdf

Date added: March 10, 2013 - Views: 5

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Changes to Reimbursement Policies - UHCCommunityP...

diagnosis code found on the Routine OB Ultrasound allowed diagnosis code list. Reimbursement for a Detailed OB Ultrasound (CPT codes 76811 and 76812) will be allowed when submitted with a diagnosis code found on the

http://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/reimbursementpolicies/UHC-ProviderBulletin-11-12.pdf

Date added: October 27, 2013 - Views: 2

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Coding In Ob Sonography - Meetingpro.info - The PLAZA Group

76811 Ultrasound, pregnant uterus, real time with image documentation, ... – Code includes ultrasound guidance so DO NOT bill that separately! 8 76805 Basic scan 1.00 +0.01 76810 Multiple* 0.97-1.00 76815 Limited 0.65 +0.00 76816 Follow-up* 0.85

http://www.meetingpro.info/plaza/registrants/GoHo09/Lectures_PDF/Copel%20Coding%20Update.pdf

Date added: November 2, 2011 - Views: 27

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National Imaging Associates, Inc. Clinical guideline ...

CPT Codes: 76805, +76810, 76811, +76812, 76815, 76816, 76817, 76820, 76821 ... Society for Maternal-Fetal Medicine (SMFM), Coding Committee. White paper on ultrasound code 76811. Announcements Washington, DC: SMFM; May 24, 2004. Retrieved from:

http://www1.radmd.com/media/523138/ob-ultrasound-guideline-2012.pdf

Date added: October 27, 2012 - Views: 33

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Ultrasound Exam for Pregnancy - Health Plan of Nevada

The Current Procedural Terminology (CPT) codes and HCPCS codes listed in this policy are for reference purposes only. ... ultrasound (76805 or 76811); or ˜ When there is high risk of a potential heart defect (congenital history, abnormal screen)

http://www.healthplanofnevada.com/documents/provider%20files/Ultrasound%20Exam%20for%20Pregnancy%20OBG020.pdf

Date added: January 27, 2012 - Views: 12

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OBSTETRICAL ULTRASOUND IMAGING GUIDELINES

¾ CPT code 76811 is limited to one procedure per pregnancy. o Ultrasound Codes: ¾ Only one of the following ultrasound procedure codes is reimbursed on the ... 2004.http://www.askleslie.net/rads/White_Paper_on_Ultrasound_Code_76811.pdf. Accessed September 22, 2009

http://www.ncdhhs.gov/dma/radiology/OBUltrasound.pdf

Date added: October 31, 2011 - Views: 94

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for Maternal Fetal Medicine, Coding Committee White Paper on ...

Society for Maternal Fetal Medicine, Coding Committee White Paper on Ultrasound Code 76811 (Revised December 27, 2012) The CPT 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal

https://old.smfm.org/attachedfiles/UltrasoundCode76811Revised-Dec272012.pdf

Date added: May 31, 2014 - Views: 1

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October 2012 2012-047 Avoid Coding Errors on Claims for ...

Terminology (CPT®) code 76811. This code is for an obstetrical ultrasound that provides an extensive analysis of the fetal anatomical elements reported in the standard obstetrical ultrasounds CPT codes 76805 and 76810. Blue Cross Medical Policy #016, ...

https://www.bcbsal.org/providers/publications/providerFacts/2012-047.pdf

Date added: November 27, 2012 - Views: 7

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Obstetrical Ultrasonography - OXHP

CPT Code 76811: will be reimbursed two times per pregnancy if billed by two different providers. If : ... for non-obstetrical transvaginal ultrasound use 76830; If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam,

https://www.oxhp.com/secure/policy/obstetrical_ultrasonography.pdf

Date added: June 28, 2013 - Views: 1

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At Long Last, a CPT Change for Obstetric Sonography

Code 76801. There has long been confusion about the proper coding for the first-trimester scan. Some advocated using 76805, arguing that they were performing a “complete” scan,

http://www.jultrasoundmed.org/content/22/1/1.full.pdf

Date added: April 1, 2012 - Views: 12

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Your Physician Based Billing? Missing a Revenue Opportunity ...

± CPT Code 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach ; single or first gestation ± CPT code 76813 Ultrasound, pregnant uterus, real

http://www.codingcert.com/wp-content/uploads/2012/05/Webinar-Handouts-OB-Ancillary-Services-Are-You-Missing-a-Revenue-Opportunity-in-your-Physician-Based-Billing1.pdf

Date added: April 21, 2013 - Views: 6

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CPT Code Guidelines Ultrasound - Lake Medical Imaging

CPT Code Guidelines Ultrasound Ultrasound Abdomen 76700 Abdomen Complete Ultrasound 76705 Abdomen Limited 93975 Abdomen Doppler 76770 Aorta/Renal Retroperitoneal Complete

http://www.lakemedicalimaging.com/Domains/www.lakemedicalimaging.com/CMSFiles/Docs/CPT%20Codes/CPT%20Code%20Guidelines%20for%20Ultrasound.pdf

Date added: November 2, 2012 - Views: 40

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CPT Codes: Ultrasounds - Howard Radiology

OB Detailed Anatomy Survey (18-20 wks).. 76811 OB Follow up..... 76816 OB Limited..... 76815 OB Re-eval (Fetal Size, Growth)..... 76816 ... CPT Codes: Ultrasounds T I 443.574.5800 F I 443.574.5822. Title: Layout 1 Author: Baker Created Date:

http://howardradiology.com/pdfs/Ultrasound%20CPT%20Codes.pdf

Date added: September 26, 2012 - Views: 64

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Adviser OBGM 0903 final - OBG Management

Are CPT 76805 and 76811 different? Both are for fetal and maternal ultrasound eval-uation, yet 76811 includes a detailed fetal anatomic exam. Our ultrasonographer says she always does a detailed fetal exam. Code 76811 (ultrasound, pregnant uterus,

http://www.obgmanagement.com/fileadmin/obg_archive/pdf/1509/1509OBGM_Adviser.pdf

Date added: May 24, 2014 - Views: 2

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Coding Edge Tests Your Knowledge - AAPC

test yourself PDF version Coding Edge Tests Your Knowledge December 2011 Get One CEU These questions are answered in articles throughout this news magazine.

http://static.aapc.com/5548A1AF-4C9F-49A2-BFE0-BFA7D2344700/c699c38a-b32f-4b68-adb4-b340b0e1b167/5fca2a13-73ab-4bf9-9cdb-1fc07318a830.pdf

Date added: October 28, 2012 - Views: 8

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Get Familiar with New OB Ultrasound Codes

OB Ultrasound Codes One of the biggest changes in radiology in 2003 involves coding for obstetrical ultrasound. ... This add-on code is used with 76811 for each additional gestation. Limited exam.For a limited transabdominal ultrasound exam, use the

http://www.hcpro.com/content/42885.pdf

Date added: November 11, 2011 - Views: 8

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Obstetrical Services Policy - UnitedHealthcare Community Plan ...

The Current Procedural Terminology ... (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, ... using the non-global obstetrical codes. Code 59409 is allowed when billed by a Birthing Center on a CMS 1500 form

http://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/reimbursementpolicies/R0064-ObstetricalServicesPolicy.pdf

Date added: October 29, 2013 - Views: 1

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APPLICABLE CPT CODES FOR FETAL MONITORING

APPLICABLE CPT CODES FOR FETAL MONITORING The information about Medicare's relative value payment below represents a national average reimbursement

http://www.medicalresources.com/pdf/Nicolet-APM-APM2-CPT-Codes.pdf

Date added: March 24, 2013 - Views: 14

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Perinatal Diagnostic Imaging - Welcome to Perinatal ...

Perinatal Diagnostic Imaging Sonogram Codes / Diagnosis Codes Reference List Medicaid often has restrictions on diagnoses used with particular procedures and the number of times a

http://www.perinatalimaging.com/Make_an_Appointment_-_Diagnosis_Codes.pdf

Date added: October 7, 2012 - Views: 2

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MRI - HCA VA Outpatient Imaging

CPT Code Reference Sheet Not all studies are performed at each location CPT CODES—HCA VA OP IMAGING Appomattox Imaging (804) 524-2340 Buford Road Imaging

http://www.hcavaopimaging.com/wp-content/uploads/2010/11/CPT-Code-Reference-Sheet-4-2012.pdf

Date added: October 22, 2012 - Views: 18

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Payable diagnosis codes and procedure codes for various claim ...

76801, 76805, 76811, 76813, 76815-76818, 80055 136 V22-V23, V28, 640.x3, 641.x3, 642.x3, ... *For code combination approach, must include one code from (A), and one code from (B) and one code from (C). ... Payable diagnosis codes and procedure codes for various claim type

http://chcmedicaid-michigan.coventryhealthcare.com/web/groups/public/@cvty_medicaid_michigan/documents/adacct/c044652.pdf

Date added: November 2, 2011 - Views: 8

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Imaging Cpt Code Reference Sheet Studies - Hca Va ...

CPT Code Reference Sheet Not all studies are performed at each location CPT CODES—HCA VA OP IMAGING Appomattox Imaging

http://www.hcavaopimaging.com/wp-content/uploads/2011/04/CPT-Code-Reference-Sheet-_1.pdf

Date added: December 16, 2011 - Views: 96

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Anthem Central Region Clinical Claims Edit #300

76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, plus detailed fetal anatomic examination, transabdominal approach; single or first gestation) does not

http://www.anthem.com/shared/noapplication/f3/s3/t0/pw_043143.pdf?na=custclaimsedits

Date added: May 17, 2012 - Views: 3

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Obstetrical Policy - OXHP

Obstetrical Policy: Reimbursement Policy (Effective 06/01/2014) 3 ©1996-2014, Oxford Health Plans, LLC • Postpartum care only (CPT code 59430)

https://www.oxhp.com/secure/policy/obstetrical_policy.pdf

Date added: May 18, 2013 - Views: 5

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Provider Type 74 Billing Guide - Nevada

Provider Type 74 Billing Guide Updated: 07/11/2012 Provider Type 74 Billing Guide pv12/05/2011 1 / 4 ... Management (E&M) office visit code. Prior Authorization Requirements ... Non-payable if 76811 has been utilized, unless a significant 2nd diagnosis

http://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74.pdf

Date added: May 26, 2012 - Views: 5

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Coding the Ob scan - The PLAZA Group, LLC - CMEs via Medical ...

76811 Ultrasound, pregnant uterus, real time with image documentation, ... – Code includes ultrasound guidance so DO NOT bill that separately!! 76805!Basic scan! 1.00! +0.01! 76810!Multiple*! 0.97! -1.00! 76815!Limited! 0.65! +0.00!

http://cmebyplaza.com/Registrants/GoHo12/Lectures/Copel%20Coding%20Update.pdf

Date added: May 12, 2013 - Views: 3

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MODIFIER 59 ARTICLE - Centers for Medicare and Medicaid Services

a. Modifier 59 is used appropriately for two services described by timed codes provided during the same encounter only when they are performed sequentially.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/modifier59.pdf

Date added: June 21, 2012 - Views: 103

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Commonwealth of Massachusetts Executive Office of Health and ...

Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page vi Community Health Center Manual

http://www.mass.gov/eohhs/docs/masshealth/transletters-2012/chc-94.pdf

Date added: September 26, 2012 - Views: 5

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maternal and fetal diagnostics - BCBSNC - Health Insurance ...

Applicable codes: 76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816, ... for CPT code ranges 76801-76818 under Billing/Coding section for Section I - Ultrasound in Maternity Care. Added Section V - First-Trimester Detection of Down Syndrome.

http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/maternal_and_fetal_diagnostics.pdf

Date added: February 4, 2012 - Views: 7

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Provider Manual: Billing section - Independence Blue Cross

1/1/2013 6.1 Billing Provider Manual 6 Overview The Billing section is designed to keep you and your office staff up to date on how to do business with us.

http://www.ibx.com/pdfs/providers/provider_manual/billing.pdf

Date added: May 8, 2013 - Views: 20

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Prenatal and Postpartum Care (PPC) - NCQA

Prenatal and Postpartum Care ... Part B: Any one code. CPT: 76801, 76805, 76811, 76813, 76815-76818, 80055 ICD-9 CM Diagnosis: ... Current Procedural Terminology © 2009 American Medical Association. All rights reserved. Prenatal and Postpartum Care

http://www.ncqa.org/portals/0/Prenatal%20Postpartum%20Care.pdf

Date added: December 28, 2012 - Views: 15

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Peach State Health Plan OB Ultrasound Management Program ...

Peach State Health Plan OB Ultrasound Management Program Frequently Asked Questions (FAQs) GENERAL 1. ... 76805 or 76811 for second trimester (76811 should only be used for the second US when the diagnosis is 642.xx, 646.xx,

http://www1.radmd.com/media/253236/peach-state-health-plan-obus-faq.pdf

Date added: April 27, 2012 - Views: 4

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Basic Versus Detailed Sonography - Journal of Ultrasound

A detailed examination (Current Procedural Terminology [CPT] code 76811) was routinely performed on all patients. Major structural abnormalities were cate-gorized on the basis of whether the structure would be included in a “basic” examination (CPT code

http://www.jultrasoundmed.org/content/28/8/1015.full.pdf

Date added: June 17, 2013 - Views: 5

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Healthcare Operations Utilization Management Protocol

D. CPT 76811 is not intended to be the routine scan performed for all pregnancies. This code is intended for a known or suspected fetal anatomic or genetic abnormality (i.e. anomalous fetus, abnormal scan this pregnancy, etc.).

http://www.healthplanofnevada.com/documents/provider%20files/Ultrasound%20Exam%20for%20Pregnancy_OBG020_092908R.pdf

Date added: February 2, 2012 - Views: 18

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SOS PCP OB Billing Instructions - UnitedHealthcare Community ...

Part A: Any one code: CPT code: 99201-99205, 99211-99215; UB-92 Revenue code: 514 Part B: Any one code. CPT Code CPT Code Description 76801 Us, Preg Uter, Real Time W/Image Document, Fetal & Maternal, 1st Trimest, Transabdom; Singl/1st Gest 76802 ...

http://www.glhp.com/LogInsert.aspx?FileAccessed=Providers/PDF/SOS/SOS_PCP_OB_Billing_Instructions.pdf

Date added: October 28, 2012 - Views: 2

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CareSource Provider Coding and Reimbursement Guidelines

These standards apply to the code/code set(s) submitted and related clinical standards for claims received either hard copy or electronically. We apply HIPAA standards to all electronically received claims. Accordingly, we accept only HIPAA compliant code sets (HCPC, CPT, ICD-9).

http://www.caresource.com/documents/oh-p-260_provider_coding_and_reimbursement_info-pdf

Date added: December 14, 2012 - Views: 2

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Radiology - Harvard Pilgrim Health Care

• Outpatient radiological services are reimbursed using the CPT code representing the services rendered. ... 76805, 76811, 76817, 76830, 76831, 76856, 76857, 76870, 76872, 76881, 76975, 77058, 77059, 77078 Global and Technical (TC-Modifier) services • 50% reduction will be applied to lower ...

https://www.harvardpilgrim.org/pls/portal/url/item/D0AD76450ED0423781AAC402D0F95F9C

Date added: November 8, 2011 - Views: 10

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76801, 76805, 76810, 76811, 76812, 76815 and 76817 9109: This ...

of claims billed for procedure codes 76801, 76805, 76810, 76811, 76812, 76815 and 76817. Affected claims were denied with Remittance Advice Details (RAD) code 9109: This service is not payable for the diagnosis billed. The system was corrected on October 19, 2010.

http://files.medi-cal.ca.gov/pubsdoco/epc/2011/12288_P15569.pdf

Date added: February 16, 2013 - Views: 4

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HCR MPP-0208-031914 Global Maternity PymtPolicy - UHA » Home

Technical component of ultrasounds (CPT code 76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816 76817, 76825, 76826, 76827, 76828, 76945, 76946) I. Policy II. Definitions III. Reimbursement Guidelines . Global Maternity Payment Policy

https://uhahealth.com/uploads/forms/form_obg_global-maternity.pdf

Date added: February 12, 2014 - Views: 1

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The American College of Radiology General Radiology ...

113 CT with contrast: CPT Code 0067T deleted. CPT Code 74262 added. 114 CT with and without contrast: CPT Codes 0145T, 0146T, 0147T, 0148T, ... 76811 76812 76813 76814 76815 76816 76817 76818 76819 76820 76821 76825 76826 76827 76828 76830 76831 76856 76857 76870 76872 76873 76880

http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/NRDR/GRID/DataDictionaryGRID.pdf

Date added: November 2, 2012 - Views: 6

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OB/GYN Billing Guide - NC DHHS

76811 • The CPT code should be billed as one detail line with one unit of service. • One ultrasound code from this group is allowed per day. ... modifiers when billing CPT code 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery.

http://www.ncdhhs.gov/dma/bulletin/OBGYNSpecBull.pdf

Date added: October 30, 2011 - Views: 160

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Policy - Nevada

Updated: 08/01/2014 Provider Type 20, 24 and 77 Billing Guide pv07/03/2014 2 / 9 CPT code 90650 is an FDA-approved HPV vaccine for females only age 9-26.

http://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf

Date added: March 31, 2012 - Views: 6

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HEDIS Quick Reference Guide - Health First

HEDIS® Quick Reference Guide The following diagnosis and/or procedure codes are in compliance with the HEDIS® 2010 Volume 2 Technical Specifications

http://www.hfni.com/images/dload/fl/WC-HEDIS-GUIDE.PDF

Date added: October 5, 2012 - Views: 2

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CPT Code Changes for 2014 RADIOLOGY - McKesson

CPT Code Changes for 2014 RADIOLOGY Myra Blankenship, CPC, CIRCC Cathy Woodall, CHC, CPC Nicholas Parish, CHC, CPC Compliance-Radiology McKesson Business Performance Services . 2 Overview Current Procedural Terminology (CPT) 2014 contains new and revised codes for a variety of diagnostic,

http://mptrms.mckesson.com/rs/MckessonPT/images/RAD_2014_CPT%20Code%20Changes%20FINAL.pdf

Date added: February 8, 2014 - Views: 42

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Claims Coding and Reimbursement Policy Update

3 Code Brief description Coverage policy: 20982 Ablation bone tumor Not covered; considered investigational; see Anthem Medical Policy Surg.00050

http://www.anthem.com/provider/nh/f5/s1/t0/pw_a032552.pdf

Date added: February 17, 2012 - Views: 24

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CCI Edits - coderscentral.com

Cataract CPT® Coding Tips A number of services are bundled into code 66982 and 66984 including those for canthotomies, iridectomies, iridotomies, capsulotomies, the use of some pharmacologic agents, etc. Some

http://www.coderscentral.com/images/HandyCoder/HandyCoderSampleOphth.pdf

Date added: October 16, 2011 - Views: 47

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HEDIS - Medical Mutual - Individual Health Insurance, Group

HEDIS Women’s Screening Codes *This code is useful only if the claim form indicates when prenatal care was initiated. **For these ranges of codes, any number can be used in the fourth digit position, but the fifth digit must contain a 3, which indicates prenatal care.

https://provider.medmutual.com/pdf/Z7620.pdf

Date added: November 2, 2011 - Views: 8