How To Use CPT Code 76805

CPT 76805 is an ultrasound code for pregnant uterus examination after the first trimester, focusing on fetal and maternal evaluation using a transabdominal approach. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 76805.

1. What is CPT 76805?

CPT 76805 is a medical billing code used for ultrasound examinations of a pregnant uterus after the first trimester (14 weeks 0 days or more) to evaluate both the fetus and the mother. This code specifically refers to a transabdominal approach, which involves placing an ultrasound transducer on the patient’s abdomen to obtain images of the developing fetus and female pelvic structures.

2. 76805 CPT code description

The official description of CPT code 76805 is: “Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation.”

3. Procedure

The 76805 procedure involves the following steps:

  1. The patient lies down on an examination table, exposing her abdomen.
  2. The provider applies a gel to the ultrasound transducer head to improve the transmission of ultrasound waves.
  3. The provider places the transducer on the patient’s abdomen and slowly moves it over the surface to obtain images of the fetus and maternal pelvic structures.
  4. Real-time images are displayed on a monitor, allowing the provider to evaluate the fetus and mother.
  5. The provider documents the findings, including any measurements and observations, in the patient’s medical record.

4. Qualifying circumstances

Patients eligible to receive CPT code 76805 services are pregnant women who have reached or surpassed 14 weeks 0 days of gestation. This code is used for single or first gestation pregnancies, and it is appropriate for routine prenatal care, as well as for monitoring high-risk pregnancies or pregnancies with suspected complications.

5. When to use CPT code 76805

It is appropriate to bill the 76805 CPT code when a provider performs a transabdominal ultrasound examination of a pregnant uterus after the first trimester to evaluate both the fetus and the mother. This code is used for routine prenatal care, monitoring high-risk pregnancies, and assessing suspected complications in the pregnancy.

6. Documentation requirements

To support a claim for CPT 76805, the following information should be documented in the patient’s medical record:

  • Indication for the ultrasound examination (e.g., routine prenatal care, high-risk pregnancy, suspected complications)
  • Date and time of the examination
  • Details of the ultrasound findings, including measurements and observations of the fetus and maternal pelvic structures
  • Any recommendations for follow-up or additional testing
  • Provider’s signature and credentials

7. Billing guidelines

When billing for CPT code 76805, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 76805 include:

  • Report add-on code +76810 for each additional gestational sac or fetus after the first trimester, along with the primary code 76805.
  • Use modifier 26 for the physician’s interpretation of the radiology service, and modifier TC for the technical component of the service.
  • Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT 76805 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2007.

9. Similar codes to CPT 76805

Five similar codes to CPT 76805 and how they differentiate are:

  • CPT 76801: Used for transabdominal ultrasound during the first trimester of pregnancy for a single or the first fetus.
  • CPT 76811: Used for transabdominal ultrasound with additional analysis of fetal anatomy.
  • CPT 76813: Used for either transabdominal or transvaginal ultrasound to measure fetal nuchal translucency.
  • CPT 76815: Used for a limited ultrasound of the pregnant uterus to examine only certain parameters.
  • CPT 76816: Used for transabdominal ultrasound for follow-up study of standard fetal growth parameters after a previous abnormal or suspect finding.

10. Examples

Here are 10 detailed examples of CPT code 76805 procedures:

  1. A routine prenatal ultrasound examination at 20 weeks gestation to assess fetal growth and development.
  2. An ultrasound examination at 16 weeks gestation to evaluate the placenta’s position and rule out placenta previa.
  3. A 22-week ultrasound to monitor a high-risk pregnancy with a history of preterm labor.
  4. An ultrasound at 18 weeks gestation to assess fetal anatomy and rule out congenital anomalies.
  5. A 24-week ultrasound to evaluate fetal growth in a pregnancy complicated by gestational diabetes.
  6. An ultrasound at 28 weeks gestation to assess amniotic fluid levels in a pregnancy with suspected oligohydramnios.
  7. A 30-week ultrasound to monitor fetal growth in a pregnancy with suspected intrauterine growth restriction.
  8. An ultrasound at 32 weeks gestation to evaluate fetal presentation and rule out breech presentation.
  9. A 34-week ultrasound to assess fetal well-being in a pregnancy complicated by maternal hypertension.
  10. A 36-week ultrasound to evaluate the umbilical cord’s position and rule out cord prolapse.

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