Coding

Hi--we recently reviewed our billing and coding for ultrasound on L&D and discovered only 2% of our triage visits were reimbursed for ultrasound last year despite the majority of our triage patients receiving at minimum a limited ultrasound--76815. There are clear indications for BPP in triage, however less clear indications for a limited ultrasound. Do you know what ICD 10 code would be eligible for reimbursement for for a limited US on L&D? Is it true that a limited ultrasound on L&D for someone who is admitted (SROM, labor etc) is included in the E/M charge and cannot be billed as a separate procedure? 

Thank you!

------------------------------
Elizabeth Coviello
------------------------------

Hi Elizabeth,
The coding committee does not give clinical advice, so we cannot provide a list of ICD-10 for which a limited study would be indicated.
On L&D, if an ultrasound is performed when indicated and all the element of that study are obtained (structures, distinct report, report sent to ordering provider, etc.), the ultrasound should then be billed separately and would not be included as part of the E/M encounter.
Fadi

------------------------------
Fadi Bsat, MD
Past Chair, SMFM Coding Committee
------------------------------

Original Message:
Sent: 04-27-2021 16:50
From: Elizabeth Coviello
Subject: Billing US on L&D

Hi--we recently reviewed our billing and coding for ultrasound on L&D and discovered only 2% of our triage visits were reimbursed for ultrasound last year despite the majority of our triage patients receiving at minimum a limited ultrasound--76815. There are clear indications for BPP in triage, however less clear indications for a limited ultrasound. Do you know what ICD 10 code would be eligible for reimbursement for for a limited US on L&D? Is it true that a limited ultrasound on L&D for someone who is admitted (SROM, labor etc) is included in the E/M charge and cannot be billed as a separate procedure?

Thank you!

------------------------------
Elizabeth Coviello
------------------------------

Hi Elizabeth
So a limited ultrasound - I assume you mean a 76815 - can be billed as long as there is a separate and distinct indication for performing this study.  For example one that is commonly used early in pregnancy may be fetal viability.  In general there are a lot of ICD-10 codes (O code set) that would be possible indications for a 76815, but it would depend on the clinical scenario and why you need a 76815 (FHR, fluid, position, placenta) versus other studies (BPP).  I would refer you to our coding tip on this topic:
https://www.smfm.org/coding/tips/119-descriptions-and-required-components-for-cpt-76805-76815-and-76816-ultrasound-procedures

An ultrasound performed on L&D can be billed but may require modifiers (professional/technical components) depending on who owns the machine, the space, the techs. You must also follow all the regular/typical reporting requirements that it is documented in a separate report and that images are saved as part of the patient's medical record.  I would assume the ultrasound machine is owned by the hospital so you would only bill the pc component (not the TC or facility fee) in general in these scenarios.  

If you need more guidance please submit the question for a formal answer from our coding committee.  I am not a certified coder, so though i can give general answers, if you want a formal response that can be used to discuss options with your medical billing department I would recommend submitting the question not on communities but on the SMFM website: 
Sign-In | SMFM.org - The Society for Maternal-Fetal Medicine

hope that helps

------------------------------
Vanita Jain, MD
Chair, SMFM Coding Committee
------------------------------

Original Message:
Sent: 04-27-2021 16:50
From: Elizabeth Coviello
Subject: Billing US on L&D

Hi--we recently reviewed our billing and coding for ultrasound on L&D and discovered only 2% of our triage visits were reimbursed for ultrasound last year despite the majority of our triage patients receiving at minimum a limited ultrasound--76815. There are clear indications for BPP in triage, however less clear indications for a limited ultrasound. Do you know what ICD 10 code would be eligible for reimbursement for for a limited US on L&D? Is it true that a limited ultrasound on L&D for someone who is admitted (SROM, labor etc) is included in the E/M charge and cannot be billed as a separate procedure?

Thank you!

------------------------------
Elizabeth Coviello
------------------------------