Reimbursement Advisor

Scanning for breech, low amniotic fluid

Author and Disclosure Information


Q If we do an ultrasound to rule out breech presentation and also to evaluate low amniotic fluid, should we code both a limited ultrasound and a follow-up ultrasound modified by-51 (multiple procedure) or -59 (distinct procedure)?

A If you are reevaluating a previously documented problem (the low amniotic fluid) and then discover or evaluate the possibility of a new one (the breech), you should be reporting only 1 codeā€”the one with the highest relative value.

If you are billing for the complete service (technical and professional component), report code 76815 (2.39 relative value units [RVUs] as opposed to 2.35 RVUs for 76816). If you are billing for the professional service only, report 76816-26 (1.20 RVUs compared to .91 RVUs for 76815-26).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Next Article: