Multi-Society Guideline for Coding, Billing, and Clinician Training for Detailed Fetal Anatomy Ultrasound in the First Trimester

Abstract

It is crucial to emphasize the significance of reimbursing Detailed First-Trimester Ultrasounds (DFTUs) and the proposed adjustment to the guidance for CPT® code 76811, traditionally associated with second-trimester ultrasounds. Historically, this code has been restricted to one examination per pregnancy, a limitation acknowledged by medical societies and underscored by payor policies. However, in light of evolving medical practices and the consensus among major imaging and women's health organizations, there is a compelling need to adapt this code for dual utilization during pregnancy. This change not only facilitates the provision of essential DFTUs but also contributes to reproductive health access in the current healthcare landscape.

Furthermore, recognizing the pivotal role of physicians in ensuring access to DFTUs is essential. Physicians play a crucial part in making these services available, and equitable access can only be achieved through proper reimbursement. Adequate payment not only encourages healthcare professionals to enhance their skills but also motivates them to seek continuous education, ultimately raising the standard of care and expanding access for individuals seeking reproductive health services.

76811—CPT® Code in category: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach, single or first gestation

Part 1: Coding and Billing (Endorsed by the American Institute of Ultrasound in Medicine [AIUM], Society for Maternal-Fetal Medicine [SMFM], American College of Obstetricians and Gynecologists [ACOG], American College of Osteopathic Obstetricians and Gynecologists [ACOOG], Society of Diagnostic Medical Sonography [SDMS], Society of Radiologists in Ultrasound [SRU], Society of Family Planning [SFP], Fetal Heart Society [FHS])

Part 2: Training and Maintenance of Competence (Endorsed by the AIUM, SMFM, ACOG, ACOOG, SDMS, SFP, FHS)

ACOG: Mark Turrentine, MD

ACOOG: Eric Carlson, DO

ACR: Lauren Nicola, MD

AIUM: Bryann Bromley; Mishella Perez, RDMS, RDCS

AIUM Staff: Therese Cooper, RDMS

FHS: Anita Moon-Grady, MD

SDMS: John Trombly, MS, RDMS

SFP: Catherine D. Cansino, MD

SMFM: Brian Iriye, MD; Vanita Jain, MD; Anthony Sciscione, DO

SRU: Carol B. Benson, MD