How To Use CPT Code 76817

CPT 76817 refers to a transvaginal ultrasound of the pregnant uterus, providing real-time images for fetal and maternal evaluation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 76817.

1. What is CPT 76817?

CPT 76817 is a medical billing code used to describe a transvaginal ultrasound procedure performed on a pregnant uterus. This imaging test uses high-frequency sound waves to obtain real-time images of the developing fetus and the mother’s organs, providing valuable information for both fetal and maternal evaluation.

2. 76817 CPT code description

The official description of CPT code 76817 is: “Ultrasound, pregnant uterus, real time with image documentation, transvaginal.”

3. Procedure

1. The provider applies a protective disposable sheath or covering over a smaller ultrasound transducer and applies gel on the transducer head.
2. The transducer is firmly inserted into the patient’s vagina.
3. The provider slowly moves the transducer around inside the vagina, transmitting ultrasound waves into the uterus.
4. These ultrasound waves reflect back to the receiving unit, which receives the waves in the form of images of the developing fetus and female pelvic structures.
5. The provider evaluates the images in real-time, assessing the health and development of the fetus and the mother’s organs.

4. Qualifying circumstances

Patients eligible to receive CPT code 76817 services are pregnant women who require a transvaginal ultrasound for fetal and maternal evaluation. This may include women with high-risk pregnancies, those experiencing complications, or those with a history of pregnancy-related issues. The provider must determine the medical necessity of the procedure based on the patient’s specific circumstances and medical history.

5. When to use CPT code 76817

It is appropriate to bill the 76817 CPT code when a provider performs a transvaginal ultrasound on a pregnant uterus for real-time fetal and maternal evaluation with image documentation. This code should be used when the transvaginal approach is medically necessary and provides a clearer image of the fetus and maternal organs than a transabdominal ultrasound.

6. Documentation requirements

To support a claim for CPT 76817, the following information should be documented:

• Patient’s medical history and reason for the ultrasound
• Date and time of the procedure
• Details of the ultrasound procedure, including the transducer type and approach used
• Findings and observations from the ultrasound images
• Provider’s interpretation of the images and any recommendations for further evaluation or treatment

7. Billing guidelines

When billing for CPT code 76817, it is essential to follow the appropriate billing guidelines and rules. If you are reporting only the physician’s interpretation for the radiology service, you should append professional component modifier 26 to the radiology code. If you are reporting only the technical component for the radiology service, you would 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 76817 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 76817

Five similar codes to CPT 76817 and how they differentiate are:

• CPT 76801: Transabdominal ultrasound for fetal and maternal evaluation during the first trimester, excluding fetal nuchal translucency measurement.
• CPT 76805: Transabdominal ultrasound for fetal and maternal evaluation after the first trimester, excluding fetal nuchal translucency measurement.
• CPT 76811: Transabdominal ultrasound for fetal and maternal evaluation with additional detailed fetal anatomic examination.
• CPT 76813: Transabdominal or transvaginal ultrasound to measure the fetal nuchal translucency, or the clear, fluid-filled space at the back of the developing fetus’s neck.
• CPT 76815: Limited ultrasound of the pregnant uterus to examine only specific parameters.

10. Examples

1. A pregnant woman with a history of miscarriages undergoes a CPT 76817 transvaginal ultrasound to evaluate the fetus’s development and the health of her reproductive organs.
2. A patient experiencing vaginal bleeding during pregnancy receives a CPT 76817 ultrasound to assess the cause and determine if there are any complications with the pregnancy.
3. A high-risk pregnancy patient undergoes a CPT 76817 ultrasound to monitor the fetus’s growth and development and evaluate the placenta’s position and function.
4. A pregnant woman with a family history of genetic disorders has a CPT 76817 ultrasound to assess the fetus for any abnormalities or developmental issues.
5. A patient with a history of ectopic pregnancies undergoes a CPT 76817 ultrasound to confirm the location of the pregnancy and evaluate the health of the fetus and maternal organs.
6. A pregnant woman with a suspected multiple gestation pregnancy has a CPT 76817 ultrasound to confirm the number of fetuses and evaluate their development.
7. A patient experiencing pelvic pain during pregnancy undergoes a CPT 76817 ultrasound to assess the cause and determine if there are any complications with the pregnancy.
8. A pregnant woman with a history of preterm labor has a CPT 76817 ultrasound to evaluate the cervix’s length and assess the risk of preterm delivery.
9. A patient with a suspected fetal anomaly undergoes a CPT 76817 ultrasound to obtain a clearer image of the fetus and evaluate its development and health.
10. A pregnant woman with a history of placenta previa has a CPT 76817 ultrasound to assess the placenta’s position and determine if there are any complications with the pregnancy.