How To Use CPT Code 76811

CPT 76811 refers to a detailed ultrasound examination of a pregnant uterus, including fetal and maternal evaluation and detailed fetal anatomic examination, performed using a transabdominal approach for a single or first gestation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 76811 procedures.

1. What is CPT 76811?

CPT 76811 is a medical billing code used to describe a detailed ultrasound examination of a pregnant uterus, including fetal and maternal evaluation and detailed fetal anatomic examination, performed using a transabdominal approach for a single or first gestation. This code is used by medical professionals to bill for the service provided to patients during their prenatal care.

2. 76811 CPT code description

The official description of CPT code 76811 is: “Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation.”

3. Procedure

1. The patient is positioned comfortably on the examination table, usually in a supine position.
2. The provider applies a water-based gel to the patient’s abdomen to improve the transmission of ultrasound waves.
3. An ultrasound transducer is placed on the patient’s abdomen and moved around to obtain images of the fetus and maternal structures.
4. The provider evaluates the fetus and maternal structures, including the placenta, amniotic fluid, and umbilical cord.
5. A detailed fetal anatomic examination is performed, assessing the brain, heart, extremities, and other organs.
6. Images are documented and measurements are taken to assess fetal growth and development.
7. The transducer is removed, and the gel is wiped off the patient’s abdomen.
8. The provider discusses the findings with the patient and provides any necessary recommendations for follow-up care.

4. Qualifying circumstances

Patients eligible to receive CPT code 76811 services are pregnant women who require a detailed ultrasound examination of their uterus, including fetal and maternal evaluation and detailed fetal anatomic examination, using a transabdominal approach. This examination is typically performed during the second trimester of pregnancy, although it may be performed earlier or later depending on the patient’s specific needs and medical history. Indications for this examination may include advanced maternal age, a history of fetal anomalies, or other risk factors for fetal abnormalities.

5. When to use CPT code 76811

It is appropriate to bill the 76811 CPT code when a detailed ultrasound examination of a pregnant uterus, including fetal and maternal evaluation and detailed fetal anatomic examination, is performed using a transabdominal approach for a single or first gestation. This code should be used when the examination is medically necessary and indicated by the patient’s specific needs and medical history.

6. Documentation requirements

To support a claim for CPT 76811, the following information should be documented in the patient’s medical record:

• Indication for the examination, such as advanced maternal age, history of fetal anomalies, or other risk factors for fetal abnormalities
• Date and time of the examination
• Details of the ultrasound examination, including the transabdominal approach and the specific structures evaluated
• Findings from the fetal and maternal evaluation, including any abnormalities or concerns identified
• Results of the detailed fetal anatomic examination, including measurements and assessments of fetal growth and development
• Images and documentation supporting the examination findings
• Recommendations for follow-up care, if applicable

7. Billing guidelines

When billing for CPT code 76811, it is important to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips and codes that apply to CPT code 76811 include:

• Report add-on code +76812 in addition to 76811 for each additional fetus examined.
• Use modifier 26 for the professional component of the radiology service if only the physician’s interpretation is being reported.
• Use modifier TC for the technical component of the radiology service if only the technical component is being reported.
• Do not append a professional or technical modifier when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 76811 was added to the Current Procedural Terminology system on January 1, 2003. There have been no updates to the code since its addition.

9. Similar codes to CPT 76811

Five similar codes to CPT 76811 and how they differentiate from CPT 76811 are:

• CPT 76801: Transabdominal ultrasound for maternal and fetal examination during the first trimester, excluding fetal nuchal translucency measurement.
• CPT 76805: Transabdominal ultrasound for maternal and fetal examination after the first trimester, excluding fetal nuchal translucency measurement.
• CPT 76813: Transabdominal or transvaginal ultrasound to measure the fetal nuchal translucency, or the translucent space in the developing fetus’s neck.
• CPT 76815: Limited ultrasound of the pregnant uterus to examine only certain parameters.
• CPT 76816: Transabdominal ultrasound for a 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 76811 procedures:

1. A 35-year-old pregnant woman with a history of a previous child with a congenital heart defect undergoes a detailed ultrasound examination to assess the fetal heart and other organs.
2. A pregnant woman with a family history of neural tube defects undergoes a detailed ultrasound examination to evaluate the fetal spine and brain.
3. A pregnant woman with gestational diabetes undergoes a detailed ultrasound examination to assess fetal growth and development.
4. A pregnant woman with a history of preterm labor undergoes a detailed ultrasound examination to evaluate the cervix and placenta.
5. A pregnant woman with a history of intrauterine growth restriction in a previous pregnancy undergoes a detailed ultrasound examination to assess fetal growth and development.
6. A pregnant woman with a history of preeclampsia undergoes a detailed ultrasound examination to evaluate the placenta and umbilical cord.
7. A pregnant woman with a history of a previous child with a chromosomal abnormality undergoes a detailed ultrasound examination to assess the fetal anatomy for any abnormalities.
8. A pregnant woman with a history of a previous child with a limb abnormality undergoes a detailed ultrasound examination to assess the fetal extremities.
9. A pregnant woman with a history of a previous child with a cleft lip and palate undergoes a detailed ultrasound examination to assess the fetal face and oral structures.
10. A pregnant woman with a history of a previous child with a kidney abnormality undergoes a detailed ultrasound examination to assess the fetal kidneys and urinary system.