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A real-time transabdominal obstetrical ultrasound, designated by CPT® Code 76811, is a diagnostic imaging procedure performed to assess the pregnant uterus and the developing fetus. This ultrasound technique utilizes high-frequency sound waves to create images of the fetus and surrounding maternal structures, allowing for a comprehensive evaluation of both fetal and maternal health. The procedure is particularly focused on providing detailed anatomical insights into the fetus, which includes examining critical structures such as the brain, heart, limbs, and abdominal organs. The ultrasound is conducted with the patient having a full bladder, which enhances the clarity of the images obtained. During the procedure, acoustic coupling gel is applied to the skin of the lower abdomen to facilitate the transmission of sound waves. The transducer is then moved across the abdomen to capture real-time images, which are recorded for further analysis. The physician interprets these images to identify any potential abnormalities and documents the findings in a written report. This procedure is essential for establishing fetal viability, determining gestational age, and evaluating the position of the fetus and placenta, among other critical assessments. CPT® Code 76811 is specifically used for the first gestation in a multiple pregnancy, while additional gestations are coded separately with CPT® Code 76812.
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Ultrasound, CPT® Code 76811, is indicated for various clinical scenarios during pregnancy. The following conditions and evaluations warrant the performance of this procedure:
The procedure for performing an obstetric ultrasound using CPT® Code 76811 involves several key steps that ensure a thorough evaluation of the fetus and the pregnant uterus. The following outlines the procedural steps:
Following the completion of the ultrasound procedure, the patient may be advised on several post-procedure considerations. Typically, there are no specific restrictions or recovery protocols required after a routine obstetric ultrasound. The patient can resume normal activities immediately. However, the physician may discuss the findings of the ultrasound with the patient, including any necessary follow-up appointments or additional testing if abnormalities were detected. It is essential for the patient to understand the results and any implications for their pregnancy. Documentation of the ultrasound findings is provided in a written report, which may be shared with other healthcare providers involved in the patient's care.
| Short Descr | OB US DETAILED SNGL FETUS | Medium Descr | US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | Long Descr | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 01 - Procedure must be performed under the general supervision of a physician. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I3B - Echography/ultrasonography - abdomen/pelvis | MUE | 1 | CCS Clinical Classification | 197 - Other diagnostic ultrasound |
This is a primary code that can be used with these additional add-on codes.
| 76812 | Female Edit Addon Code MPFS Status: Active Code APC N ASC N1 PUB 100 CPT Assistant Article Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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