How To Use CPT Code 76813

CPT 76813 is a code used for first trimester fetal nuchal translucency measurement via ultrasound; this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 76813?

CPT 76813 is a medical billing code used to describe the procedure of measuring the fetal nuchal translucency during the first trimester of pregnancy using ultrasound. This measurement is crucial in diagnosing any potential chromosomal abnormalities or defects in the developing fetus.

2. 76813 CPT code description

The official description of CPT code 76813 is: “Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation.”

3. Procedure

1. The patient is positioned comfortably, either lying down or in a semi-reclined position.
2. The provider selects either a transabdominal or transvaginal approach for the ultrasound.
3. For a transabdominal approach, the provider applies gel on the ultrasound transducer head and places it on the patient’s lower abdomen, moving it slowly to capture images of the fetus.
4. For a transvaginal approach, the provider covers the smaller transducer with a protective disposable sheath, applies gel on the transducer head, and inserts it into the patient’s vagina to perform an internal ultrasound.
5. The ultrasound captures images of the nuchal translucency in the fetus, which is the clear, fluid-filled space at the back of the neck.
6. The provider measures the thickness of the nuchal translucency and documents the findings.

4. Qualifying circumstances

Patients eligible to receive CPT code 76813 services are pregnant women in their first trimester, specifically between 11 and 14 weeks gestation. This procedure is performed to assess the risk of chromosomal abnormalities or defects in the developing fetus. It is important to note that this code is applicable for single or first gestation only.

5. When to use CPT code 76813

It is appropriate to bill the 76813 CPT code when a provider performs a first trimester fetal nuchal translucency measurement using ultrasound, either through a transabdominal or transvaginal approach. This code should be used for single or first gestation cases only.

6. Documentation requirements

To support a claim for CPT 76813, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and gestational age.
• Indication for the ultrasound, such as screening for chromosomal abnormalities or defects.
• Details of the ultrasound procedure, including the approach used (transabdominal or transvaginal) and the equipment utilized.
• Images of the fetal nuchal translucency measurement, along with a description of the findings.
• Provider’s interpretation of the results, including any recommendations for further testing or follow-up care.

7. Billing guidelines

When billing for CPT code 76813, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 76813 include:

• Report add-on code +76814 in addition to 76813 if the provider measures the nuchal translucency in each additional fetus using either a transabdominal or transvaginal approach.
• 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 the professional and technical components.

8. Historical information

CPT 76813 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Similar codes to CPT 76813

Five similar codes to CPT 76813 and how they differentiate are:

• CPT 76801: Used for transabdominal ultrasound for fetal and maternal evaluation during the first trimester, excluding fetal nuchal translucency measurement.
• CPT 76805: Used for transabdominal ultrasound for fetal and maternal evaluation after the first trimester, excluding fetal nuchal translucency measurement.
• CPT 76811: Used for transabdominal ultrasound for fetal and maternal evaluation with additional analysis of fetal anatomy.
• CPT 76815: Used for a limited ultrasound of the pregnant uterus to examine only certain parameters.
• CPT 76816: Used for a 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 76813 procedures:

1. A 32-year-old pregnant woman at 12 weeks gestation undergoes a transabdominal ultrasound to measure the fetal nuchal translucency.
2. A 28-year-old pregnant woman at 13 weeks gestation undergoes a transvaginal ultrasound to measure the fetal nuchal translucency.
3. A 35-year-old pregnant woman with a family history of chromosomal abnormalities undergoes a transabdominal ultrasound at 11 weeks gestation to measure the fetal nuchal translucency.
4. A 30-year-old pregnant woman at 14 weeks gestation undergoes a transvaginal ultrasound to measure the fetal nuchal translucency due to concerns about potential chromosomal abnormalities.
5. A 29-year-old pregnant woman at 12 weeks gestation undergoes a transabdominal ultrasound to measure the fetal nuchal translucency as part of routine prenatal care.
6. A 31-year-old pregnant woman at 13 weeks gestation undergoes a transvaginal ultrasound to measure the fetal nuchal translucency after an abnormal first trimester screening result.
7. A 34-year-old pregnant woman at 11 weeks gestation undergoes a transabdominal ultrasound to measure the fetal nuchal translucency due to concerns about the fetus’s development.
8. A 27-year-old pregnant woman at 14 weeks gestation undergoes a transvaginal ultrasound to measure the fetal nuchal translucency as part of a high-risk pregnancy assessment.
9. A 33-year-old pregnant woman at 12 weeks gestation undergoes a transabdominal ultrasound to measure the fetal nuchal translucency after a previous pregnancy with chromosomal abnormalities.
10. A 26-year-old pregnant woman at 13 weeks gestation undergoes a transvaginal ultrasound to measure the fetal nuchal translucency as part of a comprehensive prenatal care plan.