Reimbursement Advisor

‘Once per exam’ means once per encounter

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Q Can you clarify what CPT means by “once per exam, not per element”? This note comes after the limited ultrasound code.

A The code for a limited ultrasound, 76815, is meant to describe a “quick” focused look at 1 or more of the examples listed in parentheses (fetal heart beat, placental location, fetal position, qualitative amniotic fluid volume, etc) in the nomenclature for this ultrasound code.

“Once per exam, not per element” means that 76815 is reported only 1 time for that encounter, regardless of how many of the listed examples you document and regardless of the number of fetuses present.

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.

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