How To Use CPT Code 76815

CPT 76815 is a code for limited ultrasound examinations of a pregnant uterus, covering aspects such as fetal heartbeat, placental location, fetal position, and amniotic fluid volume. This article will discuss the code’s description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and provide examples of CPT 76815 procedures.

1. What is CPT 76815?

CPT 76815 is a medical billing code used for limited ultrasound examinations of a pregnant uterus. This code is specifically used when a healthcare provider performs a limited examination of certain parameters for one or more fetuses, such as fetal heartbeat, placental location, fetal position, and amniotic fluid volume.

2. 76815 CPT code description

The official description of CPT code 76815 is: “Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses.”

3. Procedure

The 76815 procedure involves the following steps:

  1. The patient lies down on an examination table, usually in a supine position.
  2. The healthcare provider applies a gel on the patient’s abdomen to improve the transmission of ultrasound waves.
  3. The provider places an ultrasound transducer on the patient’s abdomen and moves it around to obtain images of the developing fetus.
  4. Ultrasound waves travel through the patient’s tissues and reflect back to the transducer, creating images on a monitor.
  5. The provider assesses the fetal heartbeat, placental location, fetal position, and amniotic fluid volume, documenting the findings with images.

4. Qualifying circumstances

Patients eligible to receive CPT code 76815 services are pregnant women who require a limited ultrasound examination of their fetus. This may be due to concerns about fetal well-being, the need to confirm placental location, or to assess fetal position and amniotic fluid volume. The examination may be performed on one or more fetuses.

5. When to use CPT code 76815

It is appropriate to bill the 76815 CPT code when a healthcare provider performs a limited ultrasound examination of a pregnant uterus, focusing on specific parameters such as fetal heartbeat, placental location, fetal position, and amniotic fluid volume. This code should be used for examinations involving one or more fetuses.

6. Documentation requirements

To support a claim for CPT 76815, the following information should be documented:

  • Patient’s medical history and reason for the ultrasound examination
  • Date and time of the examination
  • Details of the ultrasound examination, including the parameters assessed (fetal heartbeat, placental location, fetal position, and amniotic fluid volume)
  • Image documentation of the findings
  • Interpretation and report of the ultrasound findings by the healthcare provider

7. Billing guidelines

When billing for CPT code 76815, it is essential to follow the appropriate guidelines and rules. If reporting only the physician’s interpretation for the radiology service, append professional component modifier 26 to the radiology code. If reporting only the technical component for the radiology service, append modifier TC to the radiology code. Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 76815 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been several updates to the code’s description, with the most recent change occurring on January 1, 2009.

9. Similar codes to CPT 76815

Five similar codes to CPT 76815 and how they differentiate are:

  • CPT 76801: Used for transabdominal ultrasound for fetal and maternal evaluation during the first trimester, excluding fetal nuchal translucency.
  • CPT 76805: Used for transabdominal ultrasound for fetal and maternal evaluation after the first trimester, excluding fetal nuchal translucency.
  • CPT 76811: Used for transabdominal ultrasound for fetal and maternal evaluation with additional analysis of fetal anatomy.
  • CPT 76813: Used for either transabdominal or transvaginal ultrasound to measure fetal nuchal translucency.
  • 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 76815 procedures:

  1. A pregnant woman with a history of placenta previa undergoes a limited ultrasound examination to assess the current location of the placenta.
  2. A healthcare provider performs a limited ultrasound examination to confirm fetal heartbeat in a pregnant woman who experienced reduced fetal movements.
  3. A pregnant woman with twins undergoes a limited ultrasound examination to assess the position of both fetuses before a scheduled cesarean section.
  4. A healthcare provider performs a limited ultrasound examination to evaluate amniotic fluid volume in a pregnant woman with suspected oligohydramnios.
  5. A pregnant woman with a history of preterm labor undergoes a limited ultrasound examination to assess fetal well-being.
  6. A healthcare provider performs a limited ultrasound examination to determine the position of a fetus in a pregnant woman with a breech presentation.
  7. A pregnant woman with a history of miscarriages undergoes a limited ultrasound examination to confirm fetal heartbeat in the first trimester.
  8. A healthcare provider performs a limited ultrasound examination to assess placental location in a pregnant woman with a low-lying placenta.
  9. A pregnant woman with a history of intrauterine growth restriction undergoes a limited ultrasound examination to assess amniotic fluid volume.
  10. A healthcare provider performs a limited ultrasound examination to evaluate fetal position in a pregnant woman with a transverse lie presentation.

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