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The CPT® Code 76815 refers to a limited obstetrical ultrasound performed on a pregnant uterus, utilizing real-time imaging with documentation. This procedure is specifically designed to evaluate various aspects of the fetus and the pregnant uterus, as well as the surrounding pelvic structures of the mother. During the examination, the mother is typically required to have a full bladder, which aids in obtaining clearer images. The process begins with the application of acoustic coupling gel to the skin of the lower abdomen, which enhances the transmission of ultrasound waves. A transducer is then firmly pressed against the skin and moved back and forth over the lower abdomen to capture images of the pregnant uterus, the fetus, and the surrounding pelvic structures. The ultrasound machine emits ultrasonic wave pulses that penetrate the body and reflect off the tissues, creating echoes that are recorded to form images. These images are crucial for identifying any potential abnormalities. After the procedure, the physician reviews the captured ultrasound images and provides a written interpretation of the findings. Code 76815 is specifically utilized for a limited or 'quick-look' examination, focusing on key elements such as the fetal heartbeat, placental location, fetal position, and qualitative assessment of amniotic fluid volume. This code is distinct from CPT® Code 76816, which is reserved for follow-up examinations aimed at reassessing fetal size, interval growth, or further evaluation of any anatomical fetal abnormalities identified in previous ultrasounds.
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The CPT® Code 76815 is indicated for use in specific clinical scenarios where a limited obstetrical ultrasound is necessary. The following conditions or symptoms may warrant the performance of this procedure:
The procedure for CPT® Code 76815 involves several key steps to ensure accurate imaging and assessment of the pregnant uterus and fetus. The following procedural steps are typically followed:
Following the completion of the ultrasound procedure coded under CPT® 76815, there are typically no specific post-procedure care requirements. The patient may be advised to resume normal activities unless otherwise directed by the healthcare provider. The results of the ultrasound will be discussed with the patient, and any necessary follow-up appointments or additional testing will be scheduled based on the findings. It is important for the patient to understand the implications of the ultrasound results and to ask any questions regarding their pregnancy or the health of the fetus.
| Short Descr | OB US LIMITED FETUS(S) | Medium Descr | US PREGNANT UTERUS LIMITED 1/> FETUSES | Long Descr | Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses | 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 | 09 - Concept does not apply. | 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 | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | 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 |
| 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. | 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 | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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 | FY | X-ray taken using computed radiography technology/cassette-based imaging | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PI | Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | SA | Nurse practitioner rendering service in collaboration with a physician | SB | Nurse midwife | U6 | Medicaid level of care 6, as defined by each state | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 2003-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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