How to Code Twin Delivery UltrasoundsÂ
Learn how to correctly code twin deliveries and ultrasounds for multiple-gestation pregnancies with expert tips and guidance on reporting 76811 and 76812.
OB/GYN Medical Billing & Coding Alert
Accurately reporting ultrasounds for multiple-gestation pregnancies is essential for proper reimbursement and seamless patient care. Each ultrasound monitors fetal development, from confirming viability in the first trimester to detailed anatomical assessments later in pregnancy.
Understanding the correct codes, including modifiers for additional fetuses, ensures claims are processed correctly and efficiently. By applying the correct coding practices, healthcare professionals can improve billing accuracy, reduce denials, and focus on delivering high-quality maternal and fetal care.
Correctly Assign Multiple Ultrasound Codes
Multiple-gestation pregnancies often require multiple ultrasounds. Obstetric ultrasounds assess factors such as viability, the number of fetuses, fetal position, amniotic fluid volume, fetal measurements, placental location, fetal weight estimation, and essential anatomical evaluations. When reporting ultrasounds, it is necessary to select the appropriate codes based on fetal age:
- 76801 – Ultrasound, pregnant uterus, real-time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation.
- Note: For first-trimester fetal nuchal translucency measurement, use 76813.
- +76802 – Ultrasound, pregnant uterus, real-time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure).
- Note: Use 76802 with 76801.
- For first-trimester fetal nuchal translucency measurement, use 76814.
- 76805 – Ultrasound, pregnant uterus, real-time with image documentation, fetal and maternal evaluation after the first trimester (≥ 14 weeks 0 days), transabdominal approach; single or first gestation.
- +76810 – Ultrasound, pregnant uterus, real-time with image documentation, fetal and maternal evaluation after the first trimester (≥ 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure).
- Note: Use 76810 with 76805.
Example: Reporting Ultrasound Codes for Multiple Gestations
If a physician orders an ultrasound at 12 weeks of gestation to confirm the presence of triplets, the correct codes to report would be 76801, 76802, and 76802. For each subsequent ultrasound during the pregnancy, the appropriate code is 76816 (Ultrasound, pregnant uterus, real-time with image documentation, follow-up [e.g., re-evaluation of fetal size, amniotic fluid volume, or abnormal organ systems from a previous scan], transabdominal approach, per fetus).
Modifier 59 for Multiple Fetuses
For each additional fetus examined in a multiple-gestation pregnancy, you should report 76816 with modifier 59 (Distinct procedural service). For example, with triplets, the coding would be 76816, 76816-59, and 76816-59.
Complex Ultrasound for Detailed Evaluation
If the ultrasound includes a more detailed evaluation, such as a comprehensive fetal anatomical examination and a full fetal and maternal assessment—especially in high-risk situations—then you should use the relevant complex ultrasound codes. In the case of multiple gestations, this would involve using 76811 (Ultrasound, pregnant uterus, real-time with image documentation, fetal and maternal evaluation with the detailed fetal anatomical examination, transabdominal approach; first fetus) and +76812 (for each additional fetus, listed separately in addition to the primary code).
Sophisticated Equipment for 76811 and 76812
Codes 76811 and 76812 may require advanced equipment and the expertise of a maternal-fetal medicine physician. Office-level equipment might not be sufficient to capture the detailed imaging needed for these ultrasounds. Additionally, detailed ultrasound exams must be medically necessary. For instance, an obstetrician might recommend a detailed ultrasound if the pregnancy is at an elevated risk for congenital abnormalities or congenital disabilities.
Transvaginal Ultrasounds in Multiple Gestations
Occasionally, an OB-GYN uses a transvaginal ultrasound to evaluate a multiple-gestation pregnancy. According to a coding expert, transvaginal ultrasounds are typically ordered during the first trimester, primarily for dating purposes.
For transvaginal ultrasounds, report code 76817 (Ultrasound, pregnant uterus, real-time with image documentation, transvaginal) once. If the documentation supports significant additional work by the physician, consider adding modifier 22 (Increased procedural services). However, transvaginal ultrasounds are generally not used for extensive fetal evaluations.
BillingFreedom Is Your Expert Partner in OB-GYN Medical Billing
BillingFreedom specializes in OBGYN billing services and expertly handles complex multiple-gestation pregnancies. Our team ensures accurate coding for deliveries, using appropriate codes like 59409 and 59400 for different-day deliveries while providing clear documentation to address payer requirements.
We excel at precise coding ultrasounds, including 76801, 76802, 76816, 76811, and 76812, based on fetal age, the number of fetuses, and the medical necessity of detailed imaging. Our expertise includes applying modifier 59 for multiple fetuses and managing transvaginal ultrasound billing with code 76817 and modifier 22 when applicable.
BillingFreedom’s commitment to accurate and compliant OB-GYN coding ensures timely reimbursements and reduces claim rejections. We specialize in accurately coding twin delivery claims, as well as NSTs (Non-Stress Tests) and BPPs (Biophysical Profiles) for twin pregnancies, ensuring compliance and optimal reimbursement.
For more details about our exceptional ob/gyn medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472.
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