Ob-gyn Challenge: Take the Pressure Out of a 3D US Coding

February 28, 2010

No severe problems? You may have trouble with reimbursement.

Question: The ob-gyn performed and OB ultrasound (US) on a patient. Can I bill 76376 in addition to the ultrasound if the ob-gyn used 3D?

Montana Subscriber

Answer: Yes. You can report a 3D procedure with 76805 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester [> or = 14 weeks 0 days], transabdominal approach; single or first gestation) and 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation).

However, getting it paid is another matter. If your ob-gyn is performing 3D ultrasounds, she should warn the patient that her payer may not reimburse for it, and the patient will have to pay out of pocket.

Why: Very few payers are reimbursing for 3D in the absence of severe problems that require meticulous viewing. And some payers will not approve 3D, a more expensive modality, when the suspected problem for which the ob-gyn performs it has no treatment but merely provides more information.

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@ Ob-gyn Coding Alert

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