Billing for Twin Ultrasounds

Can you bill two ultrasounds for twins?

Yes, it's possible to bill for two ultrasounds when a patient is carrying twins. Typically, each fetus in a multiple pregnancy (such as twins, triplets, etc.) requires its own ultrasound examination to monitor growth, development, and other factors. Each ultrasound provides valuable information about the health and progress of each individual fetus, and therefore, can be billed separately.

However, it's essential to ensure that the documentation supports the medical necessity for each ultrasound. This means that the physician must justify why each ultrasound was performed and what specific information was obtained from each examination. If the medical necessity criteria are met, billing for multiple ultrasounds in a twin pregnancy is acceptable and common.

An example of this would be if the patient is having twins and baby A is growing normally but baby B could have a growth restriction/malformation that needs to be checked on further.

Also, payor guidelines should be checked to see if two are covered on the same day.

Billing for an ultrasound for twins depends on the type of ultrasound performed and the specific payer’s guidelines. Here are the key steps:

1. Choose the correct CPT Code for the service performed

1. Standard ultrasound CPT codes apply, but for twins, you may need to add modifiers or bill separately for each fetus.

2. Common ultrasound CPT codes:

1. 76801 - Initial obstetric ultrasound (first trimester, single or multiple gestation)

2. 76802 - Additional gestation (used for the second fetus and beyond)

3. 76805 - Detailed fetal anatomy scan (after the first trimester, single or multiple gestation)

4. 76810 - Additional detailed scan for multiple gestation

5. 76811 - Advanced fetal anatomy scan (if medically necessary)

6. 76812 - Additional detailed scan for multiple gestation (if advanced anatomy scan performed)

7. 76815 - Limited fetal ultrasound

8. 76816 - Follow-up ultrasound (e.g., growth assessment)

9. 76817 - Transvaginal ultrasound

2. Apply the correct modifier

1. Some payers require modifier -59 or modifier -76 (repeat procedure by the same provider) on the second code.

2. If using separate line items, you may need a modifier -51 (multiple procedures).

3. Bill per fetus

1. For multiple gestations, the ultrasound for the first fetus is billed with the base code (e.g., 76801).

2. The second fetus is billed with the corresponding additional fetus code (e.g., 76802).

3. Some insurers allow billing the same base code twice with a modifier -59 to indicate a separate service.

4. Check payer-specific guidelines

1. Some insurance companies have specific policies for billing multiple gestation ultrasounds.

2. Medicaid and private insurers may have different billing requirements.

5. Medical necessity documentation

1. Ensure documentation specifies the number of fetuses and medical need for the ultrasound.

2. For high-risk pregnancies, include ICD-10 codes (e.g., O30.003 - Twin pregnancy, unspecified trimester).

Are you still unsure if you are coding correctly? Visit www.triumphmps.net or call 214-305-8805 so our experienced consultants can help.