Limited Obstetrical Ultrasound Examination

[This official statement is based on a review of the prior document and a review of the literature using the following search terms (“limited ultrasound”, “limited obstetrical ultrasound”, “CPT code 76815” and “basic ultrasound”), a review of the bibliographies of the articles obtained in the literature review, a review of the AIUM library of publications and our expert opinion.]

A limited obstetrical ultrasound examination is a focused obstetrical ultrasound examination performed to answer a specific clinical question or concern. A limited obstetrical ultrasound examination may be performed as an urgent or emergency examination or in a patient who is undergoing serial ultrasound examinations for a specific indication.  

The imaging is limited to the areas required to answer the specific clinical question and will be driven by the clinical history and physical exam as described by the referring provider and guided by the expertise and experience of the interpreting clinician.

A limited obstetrical ultrasound examination does not include a comprehensive evaluation of fetal anatomy but assumes that a standard or detailed fetal anatomic survey has been done or will be performed later in the index pregnancy. The patient should be informed that the study is limited and only seeking to answer a specific clinical question.

A standard (CPT code 76805) or follow up (CPT code 76816) examination is a more thorough and comprehensive fetal study.¹ However, in acute situations, or to provide only focused information, a limited exam (CPT code 76815) may be the more appropriate study. The type of examination ordered and/or performed is based on the clinical judgement and expertise of the referring and interpreting clinician.²

Documentation for a limited obstetrical ultrasound should comply with the  AIUM Practice Parameter for Documentation of an Ultrasound Examination and include retention of images and a final report of the findings.

Providers should meet the appropriate AIUM training guideline. Physicians should conform to the  Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Obstetrical Ultrasound Examinations. Advanced Clinical Providers should conform to the  AIUM Training Guidelines for Advanced Clinical Providers in Women’s Health Performing and Interpreting Limited Obstetric Ultrasound and have a complete understanding of their scope of practice within the state where they practice.

Diagnostic ultrasound in pregnancy should be performed only when there is a valid medical indication, using the lowest possible ultrasonic exposure setting to gain the necessary diagnostic information under the ALARA (As Low As Reasonably Achievable) principle. The Output Display Standard, an on-screen real-time display of acoustic output, should be visible and monitored for Thermal and Mechanical Index. Dwell time should be kept to a minimum.

This document is not intended to provide a formal definition of a limited ultrasound for billing or coding purposes.

References

1. American Medical Association. CPT 2019 (Current Procedural Terminology (Professional Edition)). 4th ed. Chicago, Il: American Medical Association; 2018.

2. AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations. J Ultrasound Med 2018;37:E13–E24.

Additional Resources

American College of Obstetricians and Gynecologists Task Force on Collaborative Practice. Collaboration in Practice: Implementing Team-based Care. District of Columbia: American College of Obstetricians and Gynecologists; 2016.  https://www.acog.org/-/media/project/acog/acogorg/clinical/files/task-force-report/articles/2016/collaboration-in-practice-implementing-team-based-care.pdf. Accessed July 11, 2019.

American Institute of Ultrasound in Medicine. Standards and Guidelines for the Accreditation of Ultrasound Practices Standards and Guidelines for the Accreditation of Ultrasound Practices. Approved October 31, 2015. Accessed July 25, 2019.

American Institute of Ultrasound in Medicine. AIUM practice parameter for the performance of limited obstetric ultrasound examinations by advanced clinical providers. J Ultrasound Med 2018;37:1587–1596.

American Institute of Ultrasound in Medicine. Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Obstetric Ultrasound Examinations. Reapproved October 31, 2015.

American Institute of Ultrasound in Medicine. AIUM Practice Parameter for Documentation of an Ultrasound Examination. Reapproved October 31, 2015.

American Institute of Ultrasound in Medicine. AIUM practice guideline for documentation of an ultrasound examination. J Ultrasound Med 2014;33:2219–24.

American Institute of Ultrasound in Medicine. Recommended Maximum Scanning Times for Displayed Thermal Index (TI) Values. Approved October 30, 2016. Accessed July 26, 2019.

American Institute of Ultrasound in Medicine. Medical Ultrasound Safety. 3rd ed.; 2014. Available at:  https://www.aace.com/ecnu_resources/AIUM_RESOURCES/NEED_AIUM_SAFETY_BROCHURE_HERE/AIUM_Medical_Ultrasound_Safety-ThirdEdition.pdf. Accessed July 10, 2019.